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OF  CALIFORNIA 

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DR.  GEORGE  FRICK   (1793-1870).     THE    FATHER    OF    AMERICAN 
OPHTHALMOLOGY. 


The  Development  of 

Ophthalmology  in  America 
1800  to  1870 

A  Contribution  to  Ophthalmologic 
History  and   Biography 


AN  ADDRESS  DELIVERED  IN 
ABSTRACT  BEFORE  THE  SEC 
TION  OF  OPHTHALMOLOGY 
OF  THE  AMERICAN  MEDICAL 
ASSOCIATION,  JUNE  4,  1907. 
REVISED  AND  ENLARGED. 
ILLUSTRATED  BY  SELECTED 
PORTRAITS    AND    CUTS. 


ALVIN  A.  HUBBELL,   M.D.,    Ph.D. 

PROFESSOR     OF      CLINICAL      OPHTHALMOLOGY 

IN      THF.      UNIVERSITY      OF      BUFFALO,     ETC., 

BUFFALO,     NEW     YORK 


W.   T.   KEENER  &  COMPANY 

90   Wabash    Ave.,    Chicago 

1908 


Copyright,  1907. 

BY 

ALVIN  A.  HUBBELL.  il.D. 


CHICAGO: 
MEDICAL    ASSOCIATION     PRESS 


''■omedical 

m 

CONTENTS. 


PAGE 

PREFACE        7 

INTRODUCTION ■         -         9 

FACTORS    OF    DEVELOPMENT— INSTITUTIONS    AND 

SURGEONS 16 

BIOGRAPHICAL  SKETCHES— FRICK,  HAYS,  LITTELL 

AND  OTHERS -        -         -      40 

AMERICAN     OPHTHALMOLOGIC     LITERATURE      TO 

1850 96 

SPECIAL  AMETIICAN  CONTRIBUTIONS  -         -        -     110 

TRANSITION  PERIOD  FROM  THE  OPHTHALMOLOGY 
OF  THE  PHYSICIAN  AND  SURGEON  TO  THE 
OPHTHALMOLOGY  OF  THE  SPECIALIST       -  138 

THE  PIONEER  SPECIALISTS 140 

AN  ERA  OF  RAPID  CHANGE  AFTER  1850  150 

OTHER  FACTORS  OF  ADVANCEMENT     -       -  -  174 

THE  NEW  AMERICAN  0PHTHAL:\10L0(JV       -         -  193 

CONCLUSION 196 


628872 

MEUCiNB 


PREFACE. 


Through  the  earnest  solicitations  of  numerous  es- 
teemed confreres,  I  have  Ijeen  induced  to  republish  in 
book  form  the  address  which  I  had  the  honor  to  present 
to  the  Section  of  Ophthalmolog}^  of  the  American  Med- 
ical Association  at  Atlantic  City,  N.  J.,  June  4,  1907. 
In  doing  this  I  have  availed  myself  of  the  opportunity 
to  revise  the  text  throughout,  to  rewrite  portions  of  it, 
to  make  several  additions  to  it,  and  to  incorporate  a 
number  of  cuts  and  selected  portraits.  These  portraits 
are  of  men  who  have  distinguished  themselves  more  or 
less  in  ophthalmology  during  the  period  which  I  have 
reviewed.  Some  of  them  have  never  before  been  given 
to  the  public,  and  it  is  only  through  the  extreme  courtesy 
of  professional  and  other  friends  that  I  am  enabled  to 
publish  them  now.  Those  who  have  been  especially 
helpful  to  me  in  this  regard  are  Drs.  B.  Joy  Jeffries, 
Hasket  Derby,  Edward  Eeynolds  and  Edwin  H.  Bing- 
ham, of  Boston;  Mr.  Charles  P.  Fisher,  librarian  of  tlie 
College  of  Physicians  of  Philadelphia;  Mr.  John  S. 
Brownne,  of  the  Xew  York  Academy  of  Medicine,  and 
Dr.  Herman  Knapp.  of  Xew  York;  Dr.  Walter  S. 
Steiner,  of  Hartford,  and  Drs.  Samuel  Theobald  and 
Harry  Friedenwald,  of  Baltimore.  This  collection  of 
portraits,  only  two  of  which  are  of  living  men,  viz., 
Dr.  Derby  and  Dr.  Knapp.  adds  interest,  it  seems  to 


8  PREFACE. 

me,  to  the  biographical  sketches,  and  also  serves  to 
reveal  in  their  physiogomy  something  of  the  character 
of  the  men  who  have  been  instrumental  in  establishing, 
advancing  and  dignifying  ophthalmology  as  a  specialty 
in  America. 

I  can  not  let  this  little  volume  go  forth  without  warn- 
ing my  readers  that  it  is  not  intended  to  embody  a  com- 
plete survey  of  American  ophthalmology  from  1800  to 
1870.  It  simply  sketches  the  principal  factors  of  its 
development — the  men  who  have  been  most  conspicu- 
ous in 'connection  with  it,  and  the  institutions,  in  their 
beginnings,  which  have  become  perpetual  fountains  of 
ophthalmologic  knowledge  and  experience,  as  well  as 
harbingers  of  relief  to  the  suffering  and  blind.  I  realize 
that  almost  any  one  subject  herein  touched  upon  merits 
in  itself  a  more  detailed  consideration — a  chapter  if  not 
a  volume;  but  I  trust  that  even  the  outlines  and  incom- 
plete sketches  which  I  have  given  will  not  be  entirely 
devoid  of  historical  interest,  and  that  they  may  at  least 
serve  as  landmarks  to  guide  some  future  historian  into 
a  wider  field  of  study. 

The  story  of  the  progress  of  ophthalmology  from  1870 
to  the  present  time  is  an  interesting  one,  as  I  know 
from  the  material  which  I  have  collected  and  which  I 
had  hoped  to  use  when  I  was  first  invited  to  deliver  this 
address.  Whether  or  not  it  is  to  be  told  in  the  future 
depends  largely  on  the  judgment  which  is  passed  upon 
this  first  installment.  A.  A.  H. 

212  Franklin  Street,  Buffalo,  N.  Y. 


THE  DEVELOPMENT  OF  OPHTHALMOLOGY  IN 
AMERICA:    1800  TO  1870.* 


I. 

I^^TRODLCTIO:S\ 

In  undertaking  to  indicate  the  factors  that  have  con- 
tributed to  the  development  of  ophthalmology  in  -Amer- 
ica, I  have  found  it  obligatory  to  limit  my  study  to 
Canada  and  the  United  States.  This  has  been  necessary 
because  of  lack  of  time  and  readily  available  resources 
to  go  farther,  and  also  because  our  interests  in  American 
ophthalmology  center  in  these  two  great  nations. 

An  important  question  has  also  arisen  in  this  connec- 
tion, viz.,  who  are  they,  in  this  restricted  sense,  that  are 
Americans?  Are  they  those  alone  who  Avere  reared  and 
educated  in  one  of  those  two  countries?  Or  should 
those  be  included  who,  although  foreign  born  and  for- 
eign educated,  have  come  to  these  lands  to  live,  and  who 
have  identified  themselves  with  these  peoples,  their 
thought,  their  work,  their  purposes  and  their  institu- 
tions? America,  in  the  sense  above  indicated,  and  in 
which  I  shall  hereafter  use  the  word,  is  essentially  cos- 
mopolitan, and  every  man  is  an  American  who  sub- 
scribes to  the  laws  of  the  country,  makes  himself  an  in- 

*  I  have  taken  the  liberty  of  changing  the  title  which  the  oflScers 
of  the  Section  of  Ophthalmology  of  the  A.  M.  A.  assigned  to  me 
at  the  time  I  was  honored  by  an  invitation  to  deliver  this  address. 
The  subject  suggested  was  "What  America  Has  Contributed  to  the 
Advancement   of   Ophthalmology." 


10  OPHTHALMOLOGY  IX  AMERICA. 

tegral  part  of  its  national  life,  and  labors  hand  in  hand 
with  others  for  the  common  weaL  whatever  may  have 
been  his  birthplace  or  in  whatever  country  he  may  have 
received  his  education  and  scientific  training.  Herman 
EJoapp  and  Ferdinand  C.  Hotz,  for  example,  are  to-day 
as  truly  American"  in  sentiment  and  spirit,  and  through 
ties  of  scientific  interests  and  afiiliations,  as  are  Hasket 
Derby  or  G.  C.  Savage ;  and  it  is  both  my  pleasure,  pride 
and  duty  to  recognize  them  as  Americans,  and  their 
labors  here,  as  American,  and  all  who,  like  them,  have 
adopted  America  as  their  own.  I  thus  define  what  I 
mean  by  America  and  American  that  there  may  be  no 
misconception  of  theee  terms  for  the  purpose  of  this 
occasion. 

OPHTHALMOLOGIC    ADVAXCEMEXT. 

In  its  evolution,  ophthalmology  has  advanced  at  times 
very  slowly  and  at  other  times  almost  by  bounds.  With 
the  announcement  of  Maitre-Jan  and  Brisseau  of  the 
true  nature  of  cataract  in  1T06  to  1709,  with  Cheselden's 
operation  for  artificial  pupil  in  1T28,  with  Daviel's  pub- 
lication in  IT 52  of  a  new  method  of  curing  cataract  by 
extracting  it,  with  the  discovery  of  sulphuric  ether 
anesthesia  in  184G,  with  von  Helmholtz's  invention  of 
the  ophthalmoscope  in  1851,  with  von  Graefe's  newly- 
found  surgical  relief  for  glaucoma  in  185 T,  with  Bon- 
ders' revelations  in  regard  to  the  refraction  of  the  eye 
and  its  anomalies  in  1859  to  1864,  with  Lister's  teach- 
ings of  antisepsis  and  the  protection  of  operative  wounds 
from  the  invasion  of  germs  in  1867,  with  Roller's  an- 
nouncement of  ocular  anesthesia  by  cocain  in  1884, 
ophthalmology  took  tremendous  leaps.  Other  advances, 
such  as  those  pertaining  to  anatomy,  physiology,  path- 


OPHTHALMOLOGY    IN     AMERICA.  11 

ology  and  therapeutics,  have  made  slower  pace,  but 
nevertheless  they  have  been  effective,  and  by  a  gradual 
and  cumulative  accretion  have  united  with  the  more 
rapid  advances  to  bring  to  a  higher  degree  of  perfection 
the  special  department  of  medicine,  whose  interests  it 
is  our  accredited  privilege  to  promote. 

Not  only,  therefore,  is  some  new  and  marvelous  dis- 
covery in  ocular  pathology  and  therapeutics  a  contribu- 
tion to  the  advancement  of  ophthalmology,  but  so  is 
every  well-studied  and  well-reported  case;  so  is  every 
well-planned  and  well-executed  experiment  having  for 
its  purpose  and  result  the  corroboration  of  previous 
findings  or  the  establishing  of  new  facts,  the  importance, 
however,  varying  inversely  as  the  substantiated  verity  of 
past  conclusions  or  the  need  of  new  and  additional  facts 
decrease  or  increase.  Dr.  Osier  has  said^  that  "truth 
grows,  and  its  general  evolution  may  be  traced  from 
the  tiny  germ  to  the  mature  product."  So  it  is  with 
ophthalmology.  Out  of  the  germinating  stages  of  the 
dim  and  distant  past  it  has  emerged  as  a  vital  part  of 
the  great  body  of  medicine,  and,  like  the  majestic  trunk 
to  which  it  belongs,  it  has  gradually  grown  and  extended, 
sometimes  opposed  by  the  most  blighting  influences  of 
ignorance  and  cupidity  and  sometimes  sustained  by  the 
invigorating  accessions  supplied  by  intelligence  and 
genius;  but  always  has  it  grown  by  the  accretion  and 
assimilation  of  countless  experiences,  for  the  most  part 
trifling  and  unnoticed,  seldom  striking  and  far-reaching, 
until  to-day  it  has  attained  a  degree  of  perfection,  a 
proportion  of  completeness  that  are  the  pride,  if  not  the 
wonder,  of  our  whole  profession.     Not  alone,  then,  has 

1.   Brit.  Med.  Jour.,  0(  t.  27.  1906.  p.  1077. 


12  OPHTHALMOLOGY  IX  AMERICA. 

the  genius  of  Daviel,  of  von  Helmholtz.  of  Bonders  and 
others  brought  ophthalmology  to  its  present  proportions, 
but  the  thousands  on  thousands  of  lesser  and  often  most 
trivial  observations,  devices,  inventions,  suggestions  and 
experiments  of  the  past  have  also  been  essential  factors 
in  its  growth  and  perm?>nency. 

I  agree  with  Dr.  C.  A.  Oliver,  who  says,  in  a  private 
letter,  that  "it  seems  to  me  that  each  man,  in  accord- 
ance with  his  opportunities,  contributes  his  mite:  that 
each  institution  gives  its  fruits  in  direct  relationship 
with  those  in  charge,  and  that  he  who  now  may  be  the 
least  known  and  the  most  humble  in  American  ophthal- 
molog}-  may  be  really  the  greatest." 

If  ophthalmolog}^  has  not  developed  as  rapidly  in 
America  as  in  Europe,  it  must  be  remembered  that 
there  have  been  sufficient  reasons.  With  few  exceptions 
the  medical  institutions  of  America,  both  clinical  and 
teaching,  have  been  the  outgrowth  of  private  enterprise 
and  supported  by  private  gain.  The  exceptions  have 
been  the  few  instances  where,  through  the  foundation  of 
state  university  organizations,  provisions  have  been 
made  for  medical  teaching  and  hospital  facilities. 
Physicians  and  surgeons  have  seldom  been  paid  for 
teaching  or  for  serving  a  hospital,  except,  perhaps,  either 
directly  through  the  proceeds  of  private  patronage  of 
the  institutions  which  they  may  have  been  serving,  or 
indirectly  through  the  increased  private  practice  which 
they  may  have  obtained  by  the  publicity  given  them 
through  their  medical  school  affiliations.  The  result  has 
been,  therefore,  that,  without  such  a  living  salary  as  is 
paid  to  those  attached  to  the  government  schools  and 
hospitals  of  Europe,  our  American  medical  teachers  and 


OPHTHALMOLOGY     IX     AMERICA.  13 

hospital  attendants  have  had  to  earn  their  living  out- 
side in  private  practice,  and  in  doing  this  it  has  con- 
sumed nearly  or  quite  all  of  their  time  and  energy. 

Besides  this,  there  has  been  the  insufficient  qualifica- 
tion of  our  medical  men,  incident  to  the  free  develop- 
ment of  our  medical  institutions.  The  great  liberty 
that  has  been  allowed  in  their  organization,  the  envious 
and  often  bitter  strife  that  superfluous  numbers  of  them 
has  engendered  and  the  lamentable  lack  of  government 
restrictions  and  oversight  in  their  operations,  have  pro- 
duced from  the  beginning  a  gradual  lowering  of  medical 
standards,  both  for  entrance  and  graduation  of  students, 
and  for  license  to  practice,  until  in  the  ^60s  these  were 
reduced  to  the  most  meager  proportions,  or  to  nothing. 
Our  country,  therefore,  became  flooded  with  ill-prepared, 
incompetent  and  often  fraudulent  practitioners,  who 
had  been  sent  out  by  these  inferior,  ill-equipped  private 
medical  schools.  It  was  they  who,  in  turn,  obtained 
positions  in  our  hospitals,  or  created  hospitals  of  theii 
own,  and  wdio  became,  in  large  part,  our  teachers,  I  do 
not  wish  to  be  understood  as  putting  all  institutions  oi 
all  practitioners  into  these  classes.  Their  proportionate 
numbers  were  simply  in  excess.  Many  young  men  be- 
gan the  study  of  medicine  with  better  qualifications 
than  were  demanded.  Some  faculties,  with  a  high 
sense  of  responsibility,  rose  above  their  environment 
and  had  ideals  higher  than  private  gain.  Thftse  formed 
a  residuum  of  professional  men  whose  ability,  whose 
skill,  whose  intellectual  attainments,  whose  moral 
breadth  and  depth  made  tliem  ornaments  and  an  honor 
to  our  ranks  and  maintained  the  dignity  and  the  sanc- 
tity of  the  high  and  noble  principles  of  our  profession. 


14  OPHTHALMOLOGY  IX  Ail  ERICA. 

Such  men  saved  us  from  utter  disgrace;  and  in  their 
struggle  they  were  greatly  aided  by  such  movements  as 
the  organization  of  the  American  Medical  Association 
and  of  the  American  Medical  College  Association,  by  the 
special  initiative  of  the  State  of  Illinois  in  establishing 
a  state  board  of  health  with  powers  to  demand  higher 
standards  on  the  part  of  those  who  would  practice  in 
that  state,  and  by  the  creation  of  state  boards  of  medi- 
cal examiners  in  Xew  York,  Pennsylvania  and  other 
states,  which  made  it  incumbent  on  those  who  would 
practice  in  those  states  to  possess  certain  qualifications 
preliminary  to  entering  a  medical  school,  which  required 
medical  colleges  to  maintain  certain  standards  and 
courses  of  study,  and  which  finally  required  the  appli- 
cants for  license  to  pass  specific  examinations  in  the 
principal  subjects  of  medicine.  A  great  revolution  in 
professional  standards  and  qualifications  has  followed 
since  the  various  states  have  thus  taken  the  licensing  to 
practice  out  of  the  hands  of  medical  faculties;  and  this 
progress,  too,  has  gone  on  in  spite  of  the  continued  pri- 
vate character  of  most  of  our  medical  institutions. 

The  necessity,  however,  of  relying  on  private  gain  or 
private  aid  to  meet  present  and  future  demands  of  re- 
search and  teaching  has  not  ceased.  It  has  been,  and 
still  is,  the  great  obstruction  that  impedes  our  medical 
progress  in  America,  notwithstanding  that  our  medical 
men,  on  the  average,  have  to-day  just  as  well-endowed 
brains,  just  as  astute  and  resourceful  minds  as  medical 
men  in  Europe.  In  fact,  they  arc  of  European  stuff. 
They  simply  lack  opportunity.  And  this  condition  must 
continue  till  some  government  scheme  prevails  by  which 
the  living  of  our  medical  teachers  and  investigators  is 


OPHTHALMOLOGY  IN  AMERICA.  15 

made  secure  without  consuming  all  of  their  time  and 
energy  in  practice  for  this  purpose.  But  our  ophthal- 
mologists are  alive  to  the  importance  of  research  work, 
and,  in  spite  of  the  environment,  they  are  making  com- 
mendable progress,  and  their  rewards  are  growing  richer 
and  richer. 


Jl. 

FACTORS   OF  DEVELOP.MFXT. 

The  factors  that  have  contributed  to  the  development 
of  ophthalmology  in  America  are  found  in  our  special 
ophthalmologic  institutions:  in  the  eye  clinics  of  gen- 
eral hospitals  and  dispensaries;  in  the  observations  and 
clinical  teachings  of  our  pioneer  laborers  in  the  ophthal- 
mologic field  of  practice,  and,  in  a  more  limited  way, 
of  our  great  surgeons ;  in  the  writings  of  these  men,  and 
in  the  literature,  both  American  and  foreign,  which 
they  have  disseminated  throughout  the  profession:  and 
in  inventions  and  discoveries  bearing  on  ophthalmologic 
science  and  practice.  This  review  must,  necessarily,  be 
most  incomplete,  barely  taking  a  glimpse  here  and  there, 
and  merely  noting  a  few  of  the  beginnings,  some  of  the 
special  claims,  and  a  few  of  the  most  enlightening  ob- 
servations and  suggestions. 

THE    FIRST    EYE    IXSTITUTIOXS. 

In  regard  to  institutional  and  clinical  eye  work,  our 
special  institutions  take  first  rank,  and  their  origin  and 
development  are  of  deepest  interest. 

THE   NEW   LOXDOX   EYE  IXFIRMARY. 

The  first  effort  to  establish  an  institution  for  the 
treatment  of  diseases  of  the  eye  in  this  country  was 
that  of  the  Xew  London  Eye  Infirmary. 

In  a  biographic  sketch  of  Elisha  Xorth,-  it  is  stated 

2.  Blographj'  of  Eminent  Am.  Phys.  and  Surg.,  by  R.  F.  Stone, 
1892.  p.   356. 


OPHTHALMOIAJilY  IS  AMERICA.  17 

that  he  established  in  Xew  London,  Conn.,  the  first 
eye  infirmary  in  this  country.  He  did  this  in  1817. 
His  institution  was  in  active  operation  in  1819,  as 
is  shown  by  an  advertisement  in  The  Connecticut  Ga- 
zette, a  New  London  newspaper,  in  which  Dr.  Xorth 
says :  "I  had  the  pleasure  to  prevent  total  blindness  and 
restore  sight  to  twelve  or  thirteen  persons  during  the  last 
three  years.  These  would  now  probably  be  moping  about 
in  total  darkness  and  would  be  a  burden  to  society  and 
themselves  had  it  not  been  for  my  individual  exertions.'^ 
How  long  his  "infirmary"  continued  to  exist  is  un- 
known, but  it  is  possible  that  it  was  still  alive  as  late  as 
1829,  as  Dr.  North  at  that  time  added  to  his  name,  on 
the  title  page  of  the  book  later  referred  to.  the  words 
"Conductor  of  an  Eye  Infirmary."  I  include  it  in  the 
historical  sketches  of  those  whose  history  we  know,  with- 
out regarding  it  as  one  of  especial  importance. 

NEW   YORK   EYE   INFIRMARY. 

The  next  attempt  to  provide  an  institution  for  the 
relief  of  the  poor,  afflicted  with  diseases  of  the  eye,  was 
in  New  York  City  in  1820.  The  motive  of  this  effort 
can  best  be  described  by  quoting  one  of  its  founders  and 
one  of  its  first  physicians,  the  late  Dr.  Edward  Dela- 
field,^  of  that  city. 

Some  time  in  the  year  1816  two  young  men,  recent  gradu- 
ates in  medicine  of  the  College  of  Physicians  and  Surgeons  of 
this  city,  who  had  spent  together  the  previous  year  in  the 
New  York  Hospital,  one  as  house  physician  and  the  other  as 
house  surgeon,  sailed  for  Europe.  Their  object  was  to  im- 
prove themselves  in  the  knowledge  of  the  profession  of  their 
choice.     .     .     .     They  thought   then  that  they  understood  the 

3.  Address  delivered  by  Dr.  Delafield  at  the  dedication  of  the 
new  building  of  the  New  York  Eye  Infirmary,  April  25,  1856. 


18  OPHTHALMOLOGY  I\  AMERICA. 

nature  and  treatment  of  diseases  of  the  eye  as  well  as  any 
part  of  surgery;  and  when  they  sought  abroad  for  additional 
knowledge,  it  was  with  no  especial  view  of  learning  more  on 
this  subject  than  any  other  in  medicine. 

With  these  impressions  they  arrived  in  the  city  of  London, 
where  they  had  determined  to  pursue  their  studies,  and  among 
other  public  medical  charities  were  induced  to  become  pupils 
of  the  London  Eye  Infirmary,  then  recently  founded  by  Mr. 
Saunders. 

And  here  they  soon  made  a  discovery  which  is  the  best  pre- 
lude to  all  study,  that  they  were  profoundly  ignorant  of  the 
surgery  of  the  eye,  and  that  what  they  had  been  taught  on 
that  subject  was  almost  of  no  value.  Knowing  at  the  same 
time  that  they  learned  from  the  same  sources  as  the  rest  of 
their  countrymen,  they  drew  the  inference,  which  the  result 
proved  true,  that  ophthalmic  surgery  was  comparatively  un- 
known in  America.  The  thought  flashed  on  them  that  here 
was  an  open  field  in  which  they  might  walk,  and  with  the 
ardor  of  youth  they  devoted  themselves  to  this  new  branch  of 
knowledge. 

On  their  return  to  their  country  in  the  year  1818,  the  sub- 
ject of  diseases  of  the  eye  engaged  their  earnest  attention,  and 
they  soon  came  to  the  resolution  that  they  would  establish 
in  our  city  for  the  first  time  in  America,  an  infirmary  for  cur- 
ing diseases  of  the  eye. 

.  .  .  To  demonstrate  the  good  to  be  derived  from  such 
an  institution,  they  agreed,  unaided  and  alone,  to  make  the 
experiment,  and  to  call  for  no  public  assistance,  until  they 
could  already  show  results  of  a  character  and  number  sufficient 
to  prove  how  many  poor  suffered  under  diseases  of  the  eye, 
and  how  much  could  be  done  for  their  relief. 

Accordingly,  two  rooms  were  hired  in  the  second  story  of  a 
building  in  Chatham  Street,  then  in  a  central  situation,  and 
the  few  articles  provided  the  humble  institution  required. 
Some  students  of  medicine  volunteered  to  perform  in  rota- 
tion the  duty  of  apothecary,  and  the  landlord  from  whom  the 
rooms  were  rented  acted  as  superintendent.  Small  as  was  the 
scale  on  which  our  infirmary  started,  it  had  everything  essen- 
tial to  a  public  charity;   except,  indeed,  money,  and  little  of 


OPHTHALMOLOGY  IN   AMERICA. 


19 


that  was  required,  as  nobody  was  paid  for  his  services.  It 
was  made  publicly  known  that  all  poor  persons  applying  at 
No.  45  Chatham  Street,  on  certain  days  and  hours  of  each 
week,  with  diseases  of  the  eye,  would  be  gratuitously  treated, 
and  the  necessary  medicines  and  appliances  furnished  them. 

A  single  week  proved  that  our  infirmary  would  succeed,  for 
immediately  many  poor  persons,  thus  suffering,  applied  for 
relief,  and  in  a  short  time  our  small  apartments  were  crowded 
with  them,  and  the  labor  of  caring  for  so  many  proved  far 
greater  than  was  anticipated. 


XKW    YORK    I:Y1<:   and    ear    infirmary.    KRErTEI).    18.16. 


The  undertaking  was  commenced  in  the  month  of  August, 
1820,  and  in  a  period  somewhat  less  than  seven  months  436 
patients  had  applied  and  received  the  care  and  treatment  of 
the  surgeons  of  the  infirmary.      .     .     . 

.  .  .  Having,  then,  in  this  manner,  demonstrated  that 
an  infirmary  for  curing  diseases  of  the  eye  would  be  a  great 
boon  to  the  suffering  poor  of  our  city  and  country,  it  was  de- 


20  OPHTHALMOLOGY  IX  AMERICA. 

termined  to  bring  the  subject  before  the  public,  and  appeal  to 
them  for  the  means  of  founding  and  continuing  a  public  char- 
ity for  the  cure  of  diseases  of  the  eye  in  the  city  of  New 
York. 

Of  the  tAvo  young  men  who  thus  adventured  on  an  experi- 
ment whose  success  is  this  day  demonstrated,  one  was  the 
late  Dr.  John  Kearney  Rodgers,  and  the  other  now  addresses 
you — abundantly  rewarded  for  all  the  labor  he  has  bestowed 
in  founding  and  continuing  this  charity,  by  the  satisfaction 
of  meeting  you  in  this  admirable  building,  erected  and  now 
to  be  dedicated  for  the  New  York  Eye  Infirmary . 

The  first  officers  and  directors  of  the  inistitution  were 
elected  April  21,  1821.  and  were  William  Few,  presi- 
dent: Henry  I.  Wvckoff,  first  vice-president;  John 
Hone,  second  vice-president;  John  Delafield.  Jr.,  treas- 
urer; James  I.  Jones,  secretary;  Xathaniel  Eichards, 
Benjamin  L.  Swan,  ^Yilliam  Howard,  Henry  Brevoort, 
Jr.,  Joslma  Jones,  William  Howell,  James  Boggs,  Isaac 
Pierson,  Jeromus  Johnson.  Isaac  Collins,  Cornelius 
Heyer,  Henry  Eankin.  Benjamin  Strong,  Samuel  F. 
Lambert,  Edward  W.  Laight,  Gideon  Lee;  consulting 
surgeons,  Drs.  Wright,  Post,  Samuel  Borrowe ;  surgeons, 
Drs.  Edward  Delafield,  J.  Kearney  Eodgers. 

Thus  through  the  public  spirit  and  sagacity  of  two 
young  men  began  the  now  celebrated  New  York  Eye  and 
Ear  Infirmary,  in  the  month  of  August,  1820.  Its  be- 
ginnings were  small,  but  its  needs  were  manifest,  and 
from  time  to  time  receiving  the  financial  support  of  the 
public  and  the  active  cooperation  of  the  medical  pro- 
fession it  developed  into  one  of  the  largest  and  most 
philanthropic  institutions  of  the  world. 

During  the  year  ending  Sept.  30,  1906,  2,789  persons 
were  treated  in  the  wards  of  the  infirmary  and  40,311 
cases  were  treated  in  the  out-patient  department.     The 


OPHTHALMOLOGY  IN  AMERICA.  21 

daily  average  number  of  all  cases  treated  in  both  the 
out-patient  and  in-patient  departments  was  502. 

The  records  of  the  infirmary  show  that  since  its  open- 
ing in  August,  1820,  with  the  exception  of  three  months 
during  the  prevalence  of  an  epidemic  fever  in  1822,  the 
doors  of  the  infirmary  have  never  been  closed  to  patients. 
From  the  month  of  August,  1820,  to  Sept.  30,  1906, 
there  have  been  treated  at  the  infirmary  a  total  of 
1,051,892  patients.  This  number  includes  ear,  nose 
and  throat,  as  well  as  eye  patients.  Its  further  history 
must  be  told  at  another  time. 

IXSTITLTIOX  FOR  THE  DISEASES  OF  THE  EYE  AND  EAR, 
PHILADELPHIA. 

The  next  movement  toward  the  establishment  of  an 
institution  for  the  treatment  of  diseases  of  the  eye  was 
in  Philadelphia  in  1821.  It  seemed  to  be  the  outcome 
of  the  energy  and  public  spirit  of  Dr.  George  McClel- 
lan  of  that  city,  a  young  and  ambitious  man,  then  25 
years  old,  who  was  just  entering  on  his  career  as  sur- 
geon, and  who  afterv\ard  greatly  distinguished  himself 
as  such. 

Early  in  1821  a  notice  was  published  in  a  l^hihuk'l- 
phia  medical  journal"^  of  an  intention  to  start  such  an 
institution  in  the  following  words : 

Dispensary  for  Diseases  of  the  Ei/e. — For  the  increasino; 
number  of  indio;eiit  blind  people  in  the  city  of  liberties,  a 
number  of  gentlemen  have  been  contemplating  the  institution 
of  a  society  to  afford  gratuitous  relief;  and  though  circum- 
stances at  present  prevent  more  than  a  limited  foundation, 
they  indulge  reasonable  expectations  of  being  able,  in  the 
course  of  a  few  months,  to  establish  a  much  more  exten^^ive 
charitv. 


4.  Am.  Med.  Recorder,  April  14.  1821.  iv.  402 


•22  OPHTHALMOLOGY  IX  AMERICA. 

The  object  of  this  communication  is  to  notify  those  who, 
afflicted  with  any  diseases  of  the  eyes,  can  not  compensate 
medical  services,  that  arrangements  have  been  made  with  Dr. 
McClellan  for  surgical  attendance,  and  with  Mr.  Marshall, 
Chestnut  Street,  for  medicines,  which  will  be  afforded  gratui- 
tously. Application  to  be  made  at  Dr.  McClellan's  office, 
Swan  wick   Street,  near  Walnut,  above  Sixth, 

In  the  spring    of    1822    a    further  publication  was 

made.^  stating  that : 

The  Institution  for  the  Diseases  of  the  Eye  and  Ear  had, 
during  the  past  year,  been  conducted  in  the  form  of  a  dis- 
pensary, and  the  poor  have  been  supplied  with  medicines  and 
attendance,  at  the  expense  of  a  few  subscribers,  from  the  office 
of  Di'.  McClellan  in  Swanwick  Street.  The  operations  which 
were  performed  for  cataracts,  etc.,  on  a  respectable  number  of 
blind  people,  proved  so  successful,  that  considerable  interest 
has  been  excited,  and  we  are  happy  to  announce  that  the 
institution  has  in  consequence  recently  been  extended  into  a 
hospital.  We  understand  that  more  than  one  hundred  of  the 
most  influential  citizens  of  Philadelphia  have  associated  them- 
selves together  to  support  this  interesting  establishment,  that 
a  charter  has  been  obtained  from  the  Supreme  Court  and 
attorney-general,  and  that  in  a  few  days  it  will  go  into  regu- 
lar operation  as  an  organized  hospital,  for  the  relief  of  dis- 
eases of  the  eye  and  ear. 

The  following  prominent  citizens  composed  the  first 
board  of  managers:  Hon.  Chief  Justice  Tilghman,  Right 
Rev.  Bishop  White,  Hon.  Judge  Duncan,  John  B.  Brin- 
ton,  Edward  S.  Burd,  John  W.  Cond}^,  James  C.  Fisher, 
Paul  Beck,  Hon.  Benjamin  R.  Morgan,  Richard  H.  Bay- 
ard, Thomas  Kittera,  John  M.  Scott  and  Benjamin 
Tilghman. 

The  surgeon's  first  report  was  in  part  as  follows,  bear- 
ing date  of  March  26,  1822 : 

5.   Am.   Med.   Recorder,   1822,  v,  393. 


OPHTHALMOLOGY  IN  AMERICA.  23 

Gentlemen: — In  the  month  of  March,  1821,  an  association 
of  ten  individuals  was  formed  in  this  city  for  the  purpose  of 
establishing  an  institution  for  the  relief  of  diseases  of  the  eye. 
By  the  gentlemen  who  composed  that  association,  S.  Badger, 
Esq.,  was  elected  treasurer,  with  power  to  make  all  necessary 
purchases;  Mr.  Marshall,  in  Chestnut  Street,  apothecary,  and 
I  was  honored  with  the  appointment  of  surgeon.  On  the  14th 
of  April,  1821,  an  advertisement  was  inserted,  by  a  committee 
appointed  for  that  purpose,  in  the  Medical  Recorder  and  in 
some  of  the  daily  prints  of  this  city,  announcing  the  formation 
of  the  institution,  and  inviting  the  poor  to  partake  of  its 
benefits.  Since  that  period  many  physicians  and  other  respect- 
able citizens  have  recommended  poor  persons  afflicted  with  dis- 
eases of  the  eye  to  my  care,  and  in  no  instance  has  any 
patient  so  recommended,  or  in  any  other  way  introduced,  been 
refused  the  charities  of  the  institution. 

The  report  was  signed,  "George  McClellan.'' 
Then  follows  an  abstract  of  the  cases  treated  during 
the  year,  together  with  a  detailed  report  of  some  cases 
operated  on.  There  had  been  ten  cataract  operations, 
two  of  which  were  by  extraction  and  eight  were  by 
"division'^  or  by  "depression.'^  Eight  other  cases  of 
cataract  had  not  yet  been  operated  on.  The  total  num- 
ber of  cases  of  all  kinds  was  fifty-one,  twenty-five  of 
which  had  applied  and  been  registered  during  the  "pres- 
ent month.'' 

The  American  Medical  Recorder  (vol.  vi,  p.  382)  next 
takes  notice  of  this  institution  in  1823  by  announcing 
"by  request"  that  the  "distinguished  and  public  spir- 
ited" managers  of  the  new  "Philadelphia  Hospital  for 
Diseases  of  the  Eye  and  Ear  have  so  far  organized  the 
institution  under  the  provisions  of  the  charter  as  to  pro- 
vide for  the  gratuitous  treatment  of  patients  from  every 
part  of  the  country."  It  adds  that  Dr.  McClellan,  sur- 
geon of  the  institution,  invites  his  professional  brethren 


24  OPHTHALMOLOGY  IX  AMERICA. 

to  send  poor  patients.    This  will  "confer  a  favor  on  the 
managers  and  will  forward  the  interests  of  science." 

This  institution  seemed  to  start  auspiciously,  but  for 
unknown  reasons,  perhaps  some  higher  personal  aspira- 
tions on  the  part  of  its  promoter,  such  as  the  founding 
of  Jefferson  Medical  College,  which  was  consummated 
in  1825,  and  in  which  he  was  the  moving  spirit,  it  was 
short-lived,  as  little  or  nothing  is  heard  of  it  after  1824. 
It  is  possible,  also,  that  rivalry  had  something  to  do 
with  its  decline,  as  another  Philadelphia  institution  was 
organized  at  about  the  same  time  as  this,  and  was  backed 
by  a  strong  professional  support,  and  also  appealed  with 
equal  and  probably  greater  force  to  the  public. 

PEXXSYLVAXIA    IXFIRMARY    FOR    DISEASES    OF    THE    EYE 
AND   EAR. 

This  fourth  organization  in  the  United  States,  and  the 
rival  of  Dr.  McClellan's  "Hospital,"  had  its  beginning 
in  1822.  I  am  indebted  to  the  interesting  account  pub- 
lished by  Dr.  Charles  A.  Oliver^  for  the  principal  facts 
which  I  here  present  in  regard  to  it. 

Several  gentlemen  in  Philadelphia  met  on  Feb.  8, 
1822,  for  the  purpose  of  organizing  an  infirmary  for 
treating  the  poor  afflicted  with  diseases  of  the  eye  and 
ear,  when,  as  appears  from  the  first  address  to  the  public 
in  which  the  constitution  was  included,  with  the  names 
of  the  officers,  the  following  managers  were  chosen : 
James  Gibson,  ^Yilliam  Meredith,  Charles  X.  Baucher, 
Manuel  Eyre,  Robert  M.  Patterson,  M.D.,  Clement  C. 
Biddle,  William  Mcllvaine  and  Eichard  C.  Wood.     Mr. 

6.  A  Brief  Account  of  the  Pennsj'lvania  Infirmary  for  Diseases 
of  the  Eye  and  Ear,  estabUshed  in  the  City  of  Philadelphia  in  the 
year  1822.  Medical  Library  and  Historical  Journal,  New  York, 
April,  1D()?,. 


OPHTHALMOLOGY  IN  AMERICA.  25 

James  Gibson  was  made  chairman  of  the  meeting.  Dr. 
Isaac  Hays,  secretary,  and  Mr.  Eichard  C.  Wood,  treas- 
urer. Drs.  George  B,  Wood,  Isaac  Hays,  John  Bell  and 
Robert  E.  Griffith  were  appointed  surgeons,  and  Drs. 
Phillip  S.  Physick  and  William  Gibson,  consulting  sur- 
geons. The  surgeons  were  ex  ofpciis  members  of  the 
board  of  managers.  Among  other  transactions  of  the 
meeting,  a  resolution  was  passed  constituting  the  sur- 
geons a  committee  "with  authority  to  procure  a  room  for 
an  infirmary  and  to  make  arrangements  for  carrying 
into  effect  the  objects  of  the  institution."  The  commit- 
tee was  also  instructed  to  prepare  an  address  to  the  pub- 
lic, to  have  two  hundred  and  fifty  copies  of  it  and  a 
constitution  printed  in  pamphlet  form,  and  to  frame  a 
system  of  by-laws,  all  of  which  was  to  be  reported  on  at 
the  next  meeting  of  the  board. 

A  managers'  meeting  was  held  twelve  days  later  at 
which  Mr.  William  Meredith  presided.  The  committee 
reported  a  second-story  room  at  No.  4  South  Seventh 
street  at  one  hundred  dollars  a  year,  that  it  had  made 
arrangements  with  Messrs.  A.  M.  and  E.  L.  Cohen  to 
furnish  medicines  at  a  reasonable  rate,  and  that  it  had 
prepared  an  address  and  a  constitution  and  had  them 
printed,  as  authorized,  in  pamphlet  form.  A  body  of 
by-laws  was  also  adopted  at  this  meeting,  and  certain 
forms  and  methods  for  carrying  on  the  work  of  the  in- 
stitution were  agreed  on. 

The  original  "address  to  the  public"  of  1822,  with  the 
constitution  omitted  as  pul)lished  by  Dr.  Oliver,  is  as 
follows :  ^ 

The  Pennsylvania  Infirmary  for  Diseases  of  the  Eye  and  Ear. 
Established  at  Philadelphia. 
In  calling  the  attention  and  soliciting  the  patronage  of  the 


26  OPHTHALMOLOGY  IX  AMERICA. 

public  to  an  institution  which  is  to  embrace  the  relief  of  a 
class  of  diseases  having  so  important  a  bearing  on  individual 
happiness  and  social  comfort,  Ave  need  but  advert  to  the  suc- 
cess which  has  attended  similar  ones  in  Europe,  more  particu- 
larly those  established  at  London  and  Vienna.  In  these  cities 
thousands  have  been  anually  relieved  and  cured  of  diseases  of 
the  eye  and  ear,  who  otherwise  would  have  lost  the  use  of  these 
all-important  organs,  and  proved  a  burthen  to  themselves  and 
to  society.  Like  benefits  have  resulted  from  institutions  of  the 
same  nature  in  some  of  our  own  cities,  and  we  may  now  con- 
fidently hope  that  the  citizens  of  Philadelphia,  distinguished 
for  their  zeal  and  liberality  in  the  support  of  whatever  tends 
to  usefulness  and  charity,  will  not  suffer  the  present  oppor- 
tunity to  escape  without  testifying  their  approbation  of  the 
institution  already  organized,  and  prepared  to  commence  its 
beneficial  operation,  as  will  be  seen  from  the  subjoined  con- 
stitution, adopted  at  a  respectable  meeting  of  the  contributors 
on  Friday  last. 

It  is  interesting  to  note  in  this  connection  that  pro- 
vision was  made  in  the  constitution  ''^that  clinical  in- 
struction may  be  given  under  such  regulations  as  shall 
be  provided  by  the  bj-laws." 

It  will  be  seen  by  this  "address''  that  these  managers 
entirely  ignored  Dr.  McClellan's  institution,  although 
it  had  already  been  in  operation  for  a  year,  and  although 
they  must  have  known  of  its  existence. 

The  Pennsylvania  Infirmary  had  somewhat  of  a  strug- 
gle to  live,  but  it  was  kept  in  more  or  less  successful 
operation  for  at  least  seven  or  eight  years.  It  was  not 
incorporated,  however,  till  early  in  1826.  Dr.  Oliver 
says  that  the  last  meeting  of  the  board  that  he  can  find 
recorded  was  held  on  May  1,  1829.  But  at  that  meeting 
a  committee  was  authorized  to  collect  subscriptions,  and 
other  actions  w^ere  taken  looking  toward  its  continued 
support  and  work.    In  1829  Dr.  Isaac  Hays,  in  an  article 


OPHTHALMOLOGY  //Y  AMERICA.  27 

of  much  detail  and  interest  on  "Diseases  of  the  Cor- 
nea/^'^  subscribed  himself  as  one  of  the  "Surgeons  of  the 
Pennsylvania  Infirmary  for  Diseases  of  the  Eye  and 
Ear/'  showing  that  he  was  still  active  in  the  institution, 
and  not  ashamed  of  it.  How  long  it  lived  after  1829  or 
1830  I  can  not  say.  Perhaps  it  did  so  till  James  Wills' 
legacy  became  effective  in  1834,  when  place  and  means 
were  provided  for  the  work  of  the  staff  of  surgeons,  and 
for  lack  of  which  this  was  made  difficult,  and  without 
the  desired  efficiency. 

MASSACHUSETTS    CHARITABLE   EYE   AND  EAR    INFIRMARY. 

The  fifth  institution  that  was  organized  in  this  coun- 
try and  which,  unlike  the  first  and  last  two  above  re- 
ferred to,  has  lived  to  the  present  time,  and  has  been 
both  a  credit  and  pride  to  American  opththalmology  and 
to  the  medical  profession.  This  was  the  Massachusetts 
Charitable  Eye  and  Ear  Infirmary  of  Boston,  which  was 
founded  in  1824.  Like  the  New  York  Eye  Infirmary, 
it  had  its  beginnings  through  the  enterprise  of  two  young 
Boston  physicians.  Dr.  Edward  Eeynolds  and  Dr.  John 
Jeffries.  I  can  not  do  better  in  introducing  this  brief 
historical  sketch  than  to  quote  from  an  address  of  one  of 
its  founders,  Dr.  Eeynolds,  delivered  at  the  dedication  of 
its  new  building,  on  July  3,  1850.  Among  other  things, 
Dr.  Eeynolds  said : 

As  the  London  Eye  Infirmary  owes  its  origin  to  the  Insti- 
tution at  Vienna,  so  the  Massachusetts  Infirmary,  where  we 
are  this  day  assembled,  must  claim  its  parentage  from  that. 
The  valuable  work  of  Saunders,  published  in  1816,  and  the 
occasional  reports  of  the  infirmary  of  which  it  was  the  first 
fruits,  began  to  excite  a  spirit  of  inquiry  among  several  emi- 

7.  American  Medical  Recorder,  xiii,  324. 


28  OPHTHALMOLOCY  IX  AMERICA. 

nent  individuals  in  our  country.  But  no  general  movement 
was  made  in  its  favor  until  1821  (1820);  when  the  first  eye 
infirmary  in  America  was  established  by  Dr.  John  Kearney 
Rodgers  and  Dr.  Edward  Delafield,  two  of  the  most  distin- 
guished physicians  and  surgeons  in  New  York,  who  may  be 
called  the  fathers  of  American  ophthalmology.  Filled  with  the 
spirit  first  received  at  the  London  institution,  and  finding  on 
their  return  from  Europe  a  great  number  of  poor  people 
afflicted  with  diseases  of  the  eyes,  they  were  desirous  of  ex- 
tending a  similar  blessing  to  their  native  city.  Accordingly,  at 
the  request  of  several  of  the  senior  members  of  the  profession, 
they  founded  the  New  York  Eye  Infirmary. 

Two  (four)  years  after,  in  the  latter  part  of  1824.  the 
example  was  followed  in  Boston,  and  the  first  eflFort  made, 
whose  noble  result  we  are  this  day  assembled  to  celebrate. 
Perhaps,  on  this  occasion.  I  may  be  pardoned  in  saying  that 
the  Massachusetts  Charitable  Eye  Infirmary  partly  originated 
in  the  fact  that  one  of  its  founders  had  the  happiness  of 
restoring  a  beloved  father  (Edward  Reynolds,  Esq.)  to  sight 
by  the  operation  of  cataract.  The  tender  relation  in  this  case 
of  surgeon  and  patient,  becoming  extensively  known  among 
the  small  population  then  composing  our  community,  brought 
to  his  observation  a  large  number  of  ophthalmic  patients;  and 
soon  revealed  the  fact  that  the  poor  and  laboring  classes  are 
peculiarly  liable  to  these  diseases — a  fact  now  familiar  to 
every  one  acquainted  with  the  results  of  these  institu- 
tions.    .     .     . 

.  .  .  In  the  month  of  XovemlDer,  1824.  the  speaker,  in 
conjunction  with  Dr.  John  Jeffries,  hired  a  room  in  Scollay's 
buildings;  fitted  it  with  such  conveniences  as  their  limited 
means  enabled  them  to  procure;  and  invited  the  poor,  afflicted 
with  diseases  of  the  eye.  to  come  there  for  gratuitous  aid. 
After  having  continued  their  daily  attendance  for  the  period 
of  sixteen  months,  it  was  found  that  during  this  time,  al- 
though the  population  of  the  city  did  not  exceed  50,000.  no 
less  than  886  persons  had  applied  at  the  rooms.       .     ,     , 

Having  thus  satisfactorily  tested  the  experiment,  the  sur- 
geons now  thought  the  time  had  arrived  which  authorized 
them  to  present  the  claims  of  this  large  class  of  the  poor  to 


OPHTHALMOLOGY  IN  AMERICA. 


29 


the  attention  of  the  public.  Accordingly,  a  meeting  was 
called  on  March  13,  1826,  at  which  the  Hon.  John  Wells  pre- 
sided. The  report  was  read.  Its  simple  statement  of  facts 
impressed  all  the  gentlemen  present  with  a  conviction  of  the 
usefulness  and  importance  of  the  institution,  and  determined 
them  to  give  it  a  more  perfect  trial  as  a  public  charity.  In 
accordance  with  a  vote  there  passed,  a  subscription  was  com- 
menced. By  the  personal  exertions  of  one  gentleman,  Mr. 
Lucius  Manlius  Sargent,  more  than  two  thousand  dollars  were 


MASSACHUSETTS    CHARITABLE    EYE    AND   EAR    INFIRMARY, 
BOSTON.    ERECTED   18.50. 


collected  in  one  week,  as  a  permanent  fund;  and  nearly  three 
hundred  dollars  in  annual  subscriptions. 

The  first  meeting  of  the  subscribers  who  had  thus  promptly 
replied  to  the  call  of  the  committee,  was  held  at  the  Exchange 
Coffee  House,  on  the  evening  of  March  20,  1826.  Mr.  Richard 
D.  Tucker  presided.  The  result  of  Mr.  Sargent's  efforts  being 
made  known  by  Mr.  Bryant  P.  Tilden,  was  regarded  as  a  spon- 
taneous expression  favorable  to  the  establishment  of  the  in- 
stitution. Accordingly,  it  was  then  regularly  organized  under 
the  title  of  the  Boston  Eye  Infirmary  by  the  election  of  a  board 
of    officers,    composed    of    the    following    gentlemen:      Edward 


30  OPHTHALMOLOGY  IX  AilEKICA. 

Tuckerman,  president :  Lucius  M.  Sargent,  vice  president : 
William  B.  Reynolds,  secretary;  Bryant  P.  Tilden,  treasurer: 
Richard  A.  Tucker,  Edward  H.  Robins.  Robert  G.  Shaw.  Henry 
Sargent.  Henry  Rice,  Nathaniel  G.  Snelling,  James  C.  Dunn. 
Thomas  C.  Amrory,  and  Rev.  John  Codman.  managers. 

In  February  of  the  following  year  it  was  incorporated 
by  the  legislature  of  Massachusetts  under  the  title  of  the 
Massachusetts  Eye  and  Ear  Infirmary. 

From  this  time  till  the  fall  of  1836  the  infirmary  was 
•'housed''  in  different  places,  and  was  used  only  as  a  dis- 
pensary, serious  cases  being  cared  for  by  the  staff  else- 
where. The  requirements  for  hospital  accommodations 
became  so  imperative  that  a  building,  the  Gore  House 
on  Green  street,  was  then  purchased,  and  was  remodeled 
and  adapted  to  both  dispensary  and  hospital  purposes. 
This  building  was  opened  for  admission  and  treatment 
of  patients  on  July  19,  1836.  The  number  of  patients 
registered  during  this  year  is  recorded  as  689.  It  rapidly 
increased  to  such  an  extent  that  additional  room  and 
facilities  were  found  necessary,  and  once  more  an  effort 
was  made  to  provide  larger  quarters,  which  resulted  suc- 
cessfully in  the  purchase  of  a  lot  on  Charles  street  in 
1848,  and  the  erection  of  a  new  building  which  was  com- 
pleted in  1850  and  dedicated  on  July  3  of  that  year,  the 
dedicatory  address  above  quoted  from  being  delivered 
by  one  of  its  founders.  From  that  year  the  number  of 
patients  increased  from  2,004  to  nearly  20,000  in  1895. 
The  building  of  1850  had  thus  become  inadequate  for  the 
needs  of  the  institution  and  it  was  decided  to  purchase 
adjoining  land  and  to  erect  a  new  building.  This  was 
done,  and  the  new  hospital  was  built,  and  was  ready  for 
occupancy  in  1899.  In  connection  with  this  a  ward  for 
contagious  diseases  of  the  eye  was  provided  in  an  adjoin- 


DR.   GEORGE  A.  BETHUNE    (1812-1896), 


OPHTHALMOLOGY  IN  AMERICA.  33 

ing  building,  and  is  the  first  of  its  kind  to  be  erected  in 
this  country.  The  infirmary  building  to-day  is,  like  that 
of  the  ^ew  York  Eye  and  Ear  Infirmary,  a  model  of  its 
kind.  According  to  the  last  annual  report,  1906,  the 
number  of  patients  of  all  kinds  treated  at  the  infirmary 
during  the  preceding  year  was  35,319. 

Ophthalmic  clinics  in  the  institution  were  begun  as 
early  as  1836,  and  both  Dr.  John  Jeffries  and  Dr.  E. 
Eeynolds  and  later  Dr.  George  A.  Bethune  gave  regular 
courses  on  the  diseases  of  the  eyes.  At  the  present  time 
clinical  instruction  is  given  to  the  students  of  Harvard 
and  Tufts  medical  colleges. 

BALTIMORE   DISPENSARY    FOR    THE   CURE    OF   DISEASES    OF 
THE    EYE. 

In  1823  Dr.  George  Frick,  of  Baltimore,  published 
"A  Treatise  on  Diseases  of  the  Eye.''  In  the  preface 
Dr.  Frick  says  that  "opportunity  has  been  considerably 
augmented  since  his  (the  author's)  return  to  his  native 
country,  by  his  appointment  to  the  Baltimore  Dispensary 
for  the  Cure  of  Diseases  of  the  E3^e."  Dr.  Isaac  Hays, 
of  Philadelphia,  in  reviewing  Dr.  Frick's  work  in  a 
Philadelphia  medical  journal,*  says  that  "with  respect 
to  the  institution  at  Baltimore  he  has  but  little  informa- 
tion to  communicate.  It  is  attached  to  the  Baltimore 
Dispensary  and  is  committed  to  the  author  of  this 
(Frick's)  work."  Dr.  Cordell  says,  in  his  "History  of 
the  University  of  Maryland,"  that  the  foundation  of  the 
Baltimore  Dispensary  Avas  laid  in  1823  and  ])atients 
were  received  the  same  year.  There  were  four  wards,  of 
which  "one  was  reserved  for  eve  cases,  instruction   in 


•hila.  Jour.   Med.  and  I'hys.   Sci.,   lS2r>,  pp.  409  to  427. 


34  OPHTHALMOLOGY  IN  AMERICA. 

ophthalmic  surger}'  forming  a  prominent  feature  in  the 
course."  This  being  in  the  time  of  Frick's  early  activity, 
this  prominence  given  to  ophthalmology  was  probably 
due  to  him,  and  it  was  he  who  delivered  the  lectures  re- 
ferred to. 

Dr.  Harry  Friedenwald^  says  that  on  Dr.  Frick's  re- 
turn from  Europe,  about  1819,  "to  engage  in  the  practice 
of  ophthalmolog}',  he  was  appointed  surgeon  to  the  Bal- 
timore General  Dispensary,  where  he  established  the  first 
eye  dispensary  in  Baltimore  in  1824."  This  dispensary 
must,  however,  have  been  started  before  1824,  if  Dr. 
Frick's  own  statement  above  quoted  from  his  book  be 
correct,  for  his  work  was  published  in  1823,  and  also 
according  to  CordelFs  statement,  which  I  have  above 
quoted. 

I  can  obtain  no  further  record  of  the  Baltimore  insti- 
tution, and  it  is  even  doubtful  if  it  had  an  organization 
independent  of  the  general  dispensary.  Being  a  first 
effort,  however,  at  establishing  a  special  eye  clinic  in 
Baltimore  contemporaneously  with  the  beginnings  of 
eye  infirmaries  in  Xew  York,  Philadelphia  and  Boston, 
it  is  worth  mentioning. 

WILLS   EYE  HOSPITAL. 

In  following  up  the  historical  references  to  the  early 
institutions  for  the  treatment  of  diseases  of  the  eye  which 
have  contributed  in  various  ways  to  the  advancement  of 
ophthalmology,  the  next  in  chronological  order  is  the 
Wills  Eye  Hospital  of  Philadelphia.  This  institution  was 
created  by  the  benevolence  of  a  wealthy  Philadelphian, 

9.  The  Early  History  of  Ophthalmology  and  Otology  in  Balti- 
more (1800-1850),  reprint  from  Johns  Hopkins  Hospital  Bulletin, 
Baltimore,  1897. 


OPHTHALMOLOGY  IN  AMLIilCA. 


35 


James  Wills,  who  was  born  in  England  in  1760  and  died 
in  Philadelphia  in  1830.  His  fortune  was  in  part  by  in- 
heritance and  in  part  from  his  own  business  in  Philadel- 
phia, where  he  was  an  honored  member  of  the  Society  of 
Friends.  At  his  death  he  left  a  will  providing  for  the 
founding  of  a  '^hospital  for  the  indigent  blind  and 
lame."     A  question  arose  as  to  the  legality  of  his  be- 


OLI)  WILLS   FA-I-:   HOSPITAL.   I'll  ILA  I  •!  :i .  I'l  H  A. 


quiest,  and  for  some  time  it  was  in  process  of  litigation. 
The  decision  of  the  court,  however,  upheld  the  provisions 
of  the  will,  and,  after  satisfying  other  bequests,  there 
was  a  sum  of  $108,396.35,  with  its  accumulations,  mak- 
ing a  total  of  $122,548.57,  available  for  the  purchase  of 
a  lot  and  the  erection  of  a  building  in  compliance  with 
the  wishes  of  the  benefactor.  The  place  selected  by  the 
officers  of  the  organization  was  on  Kace  street,  between 


Mi  OPHTHALMOLOGY  IX  AMERICA. 

Eighteenth  and  Nineteenth  streets,  on  which  was  erected 
a  building,  the  foundations  of  which  were  laid  on  April 
2.  1832.  On  March  3,  1834,  the  hospital  was  opened  for 
the  reception  of  patients.  On  the  completion  of  the 
building,  all  expenses  had  been  paid,  and  there  was  a 
residue  of  $65,344.88  for  the  future  support  of  the  in- 
stitution. The  first  surgeons  were  appointed  in  1834, 
and  were  Drs.  Isaac  Parrish.  Squier  Littell.  Isaac  Hays 
and  George  Fox.  Those  entitled  to  the  privileges  of  the 
hospital  were  persons  in  indigent  circumstances,  and  on 
application  they  were  expected  to  give  satisfactory  evi- 
dences of  respectable  character.  Since  the  erection  of 
the  first  building  many  alterations  and  additions  have 
been  made,  until  now  it  is  provided  with  offices,  oper- 
ating and  clinic  rooms  and  one  hundred  beds  for  interne 
patients. 

From  the  earliest  days  of  the  hospital,  eye  diseases 
were  most  prominent  among  the  patients  who  applied 
for  assistance.  As  early  as  May,  1834,  two  operations 
were  performed  for  cataract  by  couching  and,  to  quote 
the  report  of  the  visiting  committee,  "these  cases  were 
watched  with  the  utmost  interest  as  to  the  outcome  of 
the  operations."  At  first  the  full  capacity  of  the  house 
was  twenty  patients,  and  the  physicians  and  surgeons 
attended  but  once  or  twice  a  week.  The  institution  was 
then  known  as  "Wills  Hospital  for  the  Blind  and 
I.ame."'  The  character  of  the  cases  became  more  and 
more  limited  to  eye  diseases,  until  in  November,  1837. 
it  was  reported  that  there  were  no  medical  cases  for 
treatment.  A  few  years  later  the  office  of  attending 
physician  was  abandoned.  Almost  without  a  single  mo- 
ment's hesitation  has  the  institution  received  kindly  rec- 


OPHTHALMOLOGY  IN  AMERICA.  37 

ognition  and  a  helping  hand.  It  has  been  so  well  sup- 
ported by  state  and  private  benefaction  that  the  work 
has  steadily  grown  from  sixty  cases  the  first  year  to  over 
sixteen  thousand  annually  at  the  present  time. 

The  present  building  is  most  suitably  arranged  for  the 
proper  treatment  of  diseases  of  the  eye,  and  has  all  the 
modern  improvements  and  facilities. 

THE  MONTREAL  EYE  AND  EAR  IXSTITUTIOX. 

In  this  connection  I  may  properly  mention  the  Mon- 
treal Eye  and  Ear  Institution  of  Montreal,  Canada,  the 
organization  of  which  was  undoubtedly  inspired  by  Mr. 
Henry  Howard,  of  that  city,  and  which  began  its  exist- 
ence in  or  before  1846.  Information  is  not  at  hand 
which  will  enable  me  to  give  any  definite  account  of  this 
institution  and  its  duration. 

I  have  thus  taken  the  time  to  briefly  outline  the  origin 
of  these  early  institutions,  because  those  that  have  sur- 
vived have  been  the  greatest  of  the  sustaining  and  devel- 
oping forces  of  American  ophthalmology.  But  it  must 
still  be  borne  in  mind  that  these  have  been  reinforced  by 
the  organization  from  time  to  time  of  ophthalmic  serv- 
ices in  connection  with  general  hospitals  and  general  dis- 
pensaries by  men  more  or  less  interested  in  diseases  of 
the  eye.  The  Baltimore  Dispensary,  in  which  Dr.  Frick 
took  an  active  part  as  early  as  1823,  and  to  which  I  have 
already  referred,  was  one.  Another,  the  Philadelphia 
Dispensary,  a  charity  said  to  have  been  organized  by 
Benjamin  Rush,  always  had  a  certain  proportion  of 
patients  with  eye  diseases,  and  they  were  attended  to  by 
the  ph3'sicians  on  service.  The  Philadelphia  Hospital 
and  the  Pennsylvania  Hospital  of  Philadelphia,  the  New 


38  OPHTHALMOLOGY  IX  AMERICA. 

York  Hospital,  the  Massachusetts  General  Hospital  of 
Boston,  the  Baltimore  Hospital,  and  others  throughout 
the  United  States  had  their  surgeons  who  were  more  or 
less  skilled  in  ophthalmic  operations. 

SOME    OF    THESE    EARLY    SURGEONS. 

Some  of  the  early  surgeons  of  Philadelphia  who  were 
thus  skilled  were  Thomas  Bond  (iri'MTS-i),  who,  with 
Benjamin  Franklin,  founded  the  Pennsylvania  Hospital 
in  IT 5?  (the  first  of  its  kind  in  America)  ;  William 
Shippen,  Jr.  (i:36-lS08).  Philip  Syng  Physick  (1768- 
183:),  William  Gibson  (i:88-1868),  John  Syng  Dorsey 
(1T84-1818),  nephew  of  Physick;  George  McClellan 
(i:96-184:),  Jacob  Eandolph  (1196-1848),  and  George 
Fox  (1806-1882).  In  Xew  York  there  were  such  dis- 
tinguished surgeons  as  John  Jones  (1729-1791),  later 
of  Philadelphia,  Wright  Post  (1766-1822),  Samuel  Bor- 
rowe,  J.  Kearney  Eodgers  (1793-1857),  Valentine 
Mott  (1785-1840),  Gurdon  Buck  (1807-1877),  Willard 
Parker  (1800-1884),  and  Alfred  C.  Post  (1806-1886). 
In  Boston  there  were  John  Warren  (1753-1815),  his  son 
John  Collins  Warren  (1778-1856),  George  Hayward 
(1791-1868),  and  John  Jeffries  (1796-1876)  ;  in  Balti- 
more,  John   Beale   Davidge    (1769-1829),   Horatio    G. 

Jameson    (1778-1855).    John    Harper    ( 1831), 

Granville  Pattison  (1791-1851),  and  Xathan  K.  Smith 
(1797-1877);  at  Dartmouth  and  Yale,  Xathan  Smith 
(1762-1829),  the  father  of  the  Baltimore  surgeon,  and 
himself  a  great  ph3'sician  as  well  as  surgeon  of  his  day; 
in  Chicago,  Daniel  Brainard  (1812-1866)  ;  in  Transyl- 
vania. Ky.,  Benjamin  Winslow  Dudley  (1785-1870), 
and  so  on  in  all  large  towns  throughout  the  country. 


OPHTHALMOLOGY  IN  AMERICA.  39 

of  which  the  above  is  a  very  incomplete  list  and  does  not 
include  those  surgeons  of  a  little  later  period  who  were 
more  or  less  celebrated  for  their  skilful  operations  on 
the  eye. 

Those  who  stood  out  more  exclusively  for  ophthalmol- 
ogy were  George  Frick  of  Baltimore,  Isaac  Hays  and 
Squier  Littell  of  Philadelphia.  Edward  Delafield,  of 
New  York,  served  the  New  York  Eye  Infirmary  many 
years,  but  was  actively  engaged  in  other  departments  of 
practice.  Dr.  J.  K.  Eodgers  was  also  faithful  to  the  same 
institution,  but  his  service  was  incidental  to  his  surgical 
work.  John  Jeffries,  George  A.  Bethune,  John  H.  Dix, 
Eobert  W.  Hooper  and  Edward  Eeynolds,  in  Boston, 
who  attended  the  Massachusets  Charitable  Eye  and  Ear 
Infirmary,  were  also  general  practitioners.  Samuel  D. 
Gross,  Philadelphia,  was  a  great  surgeon,  and  he  also 
did  eye  surgery.  The  same  is  true  of  D.  Hays  Agnew, 
also  of  Philadelphia. 

The  lives  of  some  of  these  men  deserve  further  record 
in  this  connection  and  I  shall,  therefore,  give  sketches 
of  them  very  briefly. 


III. 

BIOGRAPHICAL  SKETCHES. 

George  Frick,  Baltimore,  was  the  first  in  America 
to  undertake  to  restrict  his  professional  work  almost 
exclusively  to  ophthalmolog5\  He  was  born  in  Balti- 
more in  IT 93.  After  completing  his  medical  studies  and 
graduating  from  the  University  of  Pennsylvania  in 
1815.  he  was  licensed  to  practice  in  his  native  city  in 
181 T.  He  visited  Europe,  where  he  became  a  favorite 
pupil  of  the  celebrated  Vienna  ophthalmologist,  Beer. 
He  came  to  feel  deeply  the  dearth  of  knowledge  of  dis- 
eases of  the  eye  in  America  and  set  himself  to  work  to  so 
qualify  himself  under  the  great  master  that  he  might 
return  to  his  home  and  give  some  enlightenment  and  a 
scientific  uplift  to  a  neglected  department  of  medicine. 
After  a  prolonged  period  of  study,  and  enthused  by  the 
example  of  Beer  as  an  exclusive  specialist,  he  returned 
to  Baltimore  in  1818  and  undertook  in  a  measure  to  fol- 
low his  teacher's  example.  He  at  once  began  his  plans 
for  ophthalmologic  work.  He  organized  a  special  eye 
clinic  in  connection  with  the  Baltimore  Dispensary  and 
established  a  course  of  lectures  on  the  eye  in  the  Uni- 
versity of  Maryland.  He  was  naturally  retiring  in  dis- 
position, and  without  demonstration  he  undertook  this 
innovation.  There  is  sufficient  evidence  extant  to  show 
that  his  work  as  an  ophthalmologist  was  approved  in 
Baltimore,  and  had  it  not  been  for  a  frail  physique  and 
the  infirmity  of  deafness  he  would  undoubtedly  have  left 
a  more  impressive  and  lasting  record  than  he  has. 


DR.  ISAAC  HAYS    (1796-1879.) 


:'  OPHTHALMOLOGY  IN  AMERICA.  43 

Nevertheless,  his  clinical  work  in  ophthalmology  be- 
came an  inspiration  to  others,  and  his  ophthalmologic 
contributions  to  the  American  Medical  Recorder  of  Phil- 
adelphia and  his  'Treatise  on  tlie  Eye"  (1823)  are 
enduring  monuments  to  his  learning.  Unfortunately, 
as  his  infirmity  increased,  and  having  tastes  for  other 
pursuits,  he  was  led  to  abandon  his  profession  so  well 
begun.  He  finally  repaired  to  Dresden,  where  he  died 
in  1870,  at  77  years  of  age.  (For  these  facts  regarding 
Dr.  Frick's  life  I  am  indebted  to  Dr.  Harry  Frieden- 
wald's  "Early  History,"  etc.,  above  cited.) 

Isaac  Hays. — The  next  who  did  much  credit  to  early 
ophthalmology  was  the  distinguished  Isaac  Hays,  who 
was  born  in  Philadelphia  in  1796  and  died  there  in 
1879,  spending  the  whole  of  his  life  in  that  city  in  most 
arduous  and  productive  labor.  He  graduated  in  medi- 
cine from  the  University  of  Pennsylvajiia  in  1820,  and, 
unaided  by  friends  or  by  the  patronage  of  the  great  and 
influential  of  his  city,  he  began  the  world's  struggles, 
and  at  once  won  the  confidence  of  the  most  distinguished 
physicians  with  whom  he  came  in  contact.  Fitted  by 
Xature  and  by  training  for  literary  work,  he  neverthe- 
less took  a  deep  interest  in  ophthalmology,  both  scien- 
tifically and  practically,  and  so  far  as  he  practiced  medi- 
cine at  all  it  was  chiefly  in  this  field.  He  began  the 
practice  of  ophthalmology  early  in  life,  and  when  the 
Pennsylvania  Infirmary  for  Diseases  of  the  Eye  and 
Ear  was  founded  in  1822,  undoubtedly  as  a  rival  to  Dr. 
McClellan's  hospital,  he  was  one  of  its  first  surgeons. 
His  services  there  were  faithful  and  efficient,  and  it  was 
also  to  his  influence  and  energy  that  it  was  kept  alive 
till  the  time  when  James  Wills  died  in  1830  and  left  a 


44  OPHTHALMOLOdY  IX  AMERICA. 

bequest,  whereby  there  would  be  means  to  support  an 
institution  in  which  charitable  work  of  this  kind  could 
be  done  in  accordance  with  higher  ideals  and  with  less 
worry  over  insufficient  financial  support.  At  the  open- 
ing of  the  Wills  Hospital  for  the  Blind  and  Lame  in 
1834,  Dr.  Hays  became  one  of  its  surgeons.  H^re  his 
masterful  influence  greatly  dominated  its  work,  and 
here,  too,  he  built  up  an  enviable  reputation  as  a  skilled 
and  progressive  ophthalmologist.  In  the  meantime  he 
contributed  numerous  learned  articles  on  ophthalmologic 
subjects  to  the  journal  with  which  he  became  identified 
when  a  young  man,  viz.,  the  Journal  of  the  Medical  and 
Physical  Sciences,  afterward  the  American  Journal  of 
the  Medical  Sciences,  a  journal  which  has  come  down  to 
our  own  time,  and  which  has  ever  been  the  pride  of  our 
profession  and  an  honor  to  its  editors  and  its  publishers. 
Dr.  Hays'  service  at  the  Wills  Hospital  continued  till 
1854.  a  period  of  twenty  years,  when  the  pressure  of  lit- 
erary work  led  him  to  resign.  During  all  of  those  years 
of  institutional  work,  from  1822  to  1854,  the  knowledge 
which  he  acquired  of  ophthalmology,  both  practical  and 
theoretical,  was  most  etticiently  and  advantageously  re- 
flected to  the  public  in  the  lectures  which  he  gave  in  Dr. 
Godman's  private  school  and  at  the  eye  hospitals  with 
which  he  was  connected;  in  the  editorial  work  of  his 
journal:  in  his  original  articles,  and  in  the  notes  which 
he  discriminatingly  added  to  his  American  edition  of  T. 
Wharton  Jones'  "Principles  and  Practice  of  Ophthalmic 
Surgery,"  and  to  his  two  editions  of  Lawrence's  "Treat- 
ise on  Diseases  of  the  Eye." 

Dr.  Hays,  besides  contributing  many  articles  of  great 
value  to  his  journal,  made  important  devices  in  ophthal- 


DR.    SQUIER   LITTBLL    (1803-1886). 


OPHTHALMOLOGY  IN  AMERICA.  47 

inic  instruments^  occupied  many  positions  of  trust,  and 
kept  alive  the  newer  and  more  progressive  ideas  touching 
the  science  and  practice  of  ophthalmology.  The  extent 
and  value  of  his  lahors  in  this  tield  alone  can  not  he 
measured. 

On  withdrawing  from  the  Wills  Hospital,  he  also 
withdrew  from  the  practice  of  ophthalmology;  hut  as 
long  as  he  lived  his  interest  in  the  subject  was  never 
lost.  Although  he  did  not  endeavor  to  make  it  an  ex- 
clusive department  of  practice,  the  world  will  always 
claim  him  as  the  great  American  editor-ophthalmologist 
of  the  first  half  of  the  nineteenth  century,  whose  learn- 
ing and  skill  were  the  admiration  and  inspiration  of  the 
practitioners  of  that  period. 

Squier  Littell. — A  third  name  that  stands  out  in 
bold  relief  in  the  same  historical  period  is  that  of  Squier 
Littell.  He  was  born  in  Burlington,  Vt.,  in  1803  and 
died  in  Philadelphia  in  1886.  He  was  one  of  a  family 
who  was  endowed  with  literary  tastes.  It  Avas  his 
brother  who  founded  that  old  and  still  popular  maga- 
zine, "Littell's  Living  Age."  Dr.  Littell  also  possessed 
a  strong  religious  nature,  and  his  literary  predisposition 
was  shown  both  in  medicine  and  in  religion.  After 
studying  medicine  with  Dr.  Joseph  Parrish  of  Phila- 
delphia, he  graduated  from  the  University  of  Pennsyl- 
vania in  1824.  He  then  entered  into  general  practice, 
making  his  first  attempt  at  this  in  South  America,  but 
returning  to  Philadelphia  in  1826,  where  he  remained 
the  rest  of  his  life.  His  retiring  and  modest  disposition, 
his  consequent  lack  of  aggressiveness,  contributed  to  a 
slow  acquirement  of  practice.  The  death  also  of  his 
young  and  charming  wife,  who  left  to  liim  a  little  daugh- 


48  OPHTHALMOLOGY  IX  AMERICA. 

ter  and  an  infant  son.  so  overwhelmed  him  with  grief 
from  which  he  did  not  recover  in  years,  tliat  it  in  a  great 
measure  stifled  his  ambition  and  diverted  him  into  chan- 
nels of  thought  and  labor,  which,  to  say  the  least,  did 
not  contribute  to  enviable  success  in  general  practice. 
Xot  to  dwell,  however,  on  these  or  on  his  literary  labors 
in  medical  journalism  and  in  religious  publications,  it 
should  be  mentioned  that  he  early  contributed  several 
important  papers  on  general  medicine  and  was  esteemed 
a  physician  and  medical  writer  of  merit.  In  1834,  on 
the  organization  of  the  Wills  Hospital,  and  perhaps 
through  the  kind  offices  of  Dr.  Parrish,  his  preceptor 
and  friend,  he  was  appointed  one  of  its  surgeons.  He 
was  a  faithful  and  conscientious  attendant  to  this  insti- 
tution for  thirty  years,  resigning  in  1864.  He  disclaimed 
any  title  to  being  a  specialist,  and  regarded  himself  sim- 
ply as  a  general  practitioner,  and  yet  his  attachment  to 
an  eye  hospital  had  more  or  less  effect  in  making  his  oph- 
thalmic practice  disproportionately  the  larger  part.  His 
experience  in  the  ^)'ills  Hospital  and  in  private  practice 
bore  good  fruit,  for,  while  Dr.  Littell  did  not  write  ex- 
tensively, his  best  contributions  were  in  the  interests 
of  an  advanced  ophthalmology.  His  "Manual  on  Dis- 
eases of  the  Eye,''  1837,  was  his  most  conspicuous  and 
helpful  production.  In  1S53  he  edited  the  first  Ameri- 
can edition  of  H.  H.  Walton's  "Treatise  on  Operative 
Ophthalmic  Surgery,''  adding  some  useful  notes. 

The  first  article  which  the  doctor  published  in  a  med- 
ical journal  was  in  1821  and  the  last  was  in  18T3, 
numbering  in  all  about  twenty.  Of  these  only  three  or 
four  were  on  the  eye.  On  the  discovery  of  the  ophthal- 
moscope Dr.  Littell  at  once  recognized  its  value  and  its 


OPHTHALMOLOGY  IN  AMERICA.  49 

practical  application  to  diagnosis  and  treatment.  He, 
although  conservative  by  nature  and  slow  to  adopt  new 
methods,  at  once  devoted  himself  to  mastering  the  diffi- 
culties of  the  new  instrument  ?.nd  used  it  habitually  and 
intelligently  in  his  practice. 

Dr.  Littell,  having  had  a  good  constitution  and  having 
led  a  regular  and  temperate  life,  had  kept  comparatively 
young  to  advanced  age.  As  he  approached  his  eightieth 
year  his  sight  began  to  fail  him  from  a  chorioidal  affec- 
tion and  was  one  of  the  severe  trials  of  his  old  age,  but 
he  made  no  complaint,  and  to  the  last,  as  his  l)lindness 
increased,  he  adapted  himself  to  his  privation. 

Like  Dr.  Hays,  this  pioneer  ophthalmologist  portraved 
those  qualities  of  mind  and  heart  which  should  stand  as 
an  example  to  all  young  men  in  generations  to  come. 

THE    THREE    PIONEERS. 

These  three  men,  Frick,  Hays  and  Littell,  unlike  all 
others  in  the  first  half  of  the  last  century,  almost  com- 
pletely divorced  themselves  in  practice,  though  not  in 
theory,  from  other  departments  of  medicine.  Each  one 
was  modest  and  conservative  by  nature,  each  was  refined 
and  cultured,  and  each  was  endowed  with  literary  tastes. 
Each  was  full  of  the  feeling  of  the  great  responsibility 
of  his  work,  and  each  had  an  unselfish  desire  to  better 
the  ophthalmic  practice  of  his  time  and  to  lead  others 
to  a  higher  plane  of  ophthalmologic  knowledge.  They 
practiced  according  to  the  best  information  and  expe- 
rience available,  and  they  opened  their  clinics  to  those 
who  would  come.  In  ophthalmology  they  stood  above  all 
others  in  the  extent  of  their  practice,  in  their  self-sacri- 
ficing devotion  to  their  work  and  in  the  literary  contri- 


50  OPHTHALIIOLOUY  IX  AMERICA. 

butions  which  were  the  outgrowth  of  their  knowledge 
and  experience^  and  which  served  so  effectually  to  ad- 
vance the  science  in  America  and  to  enlighten  the  pro- 
fession on  a  neglected  subject. 

OTHER    SKETCHES. 

There  were  others,  however,  who  were  the  contem- 
poraries of  Frick,  Hays  and  Littell,  or  who  came  later, 
who  did  less  writing,  but  who  did  most  important  service 
in  ophthalmology.  Their  careers  should  also  be  briefly 
noted. 

Elisha  Xokth  ( 17  T  1-1 843),  of  Xew  London,  Conn., 
attempted  to  make  ophthalmology  more  or  less  promi- 
nent in  his  practice,  even  earlier  than  did  either  of  the 
three  men  whose  lives  I  have  sketched.  He  was  the  son 
and  grandi^on  of  physicians,  and  studied  medicine  in 
Hartford,  and  subsequently  in  Philadelphia  under  Ben- 
jamin Rush.  After  being  admitted  to  practice  he  settled 
in  his  native  town,  Goshen,  Conn.,  and  engaged  in  the 
pursuit  of  his  profession  until  1812,  when  he  removed  to 
New  London,  Conn.  He  was  a  man  of  progress  and  was 
among  the  earliest  to  practice  vaccination  in  the  United 
States,  being  the  first  to  introduce  vaccine  matter  in  N'ew 
York  City,  sending  it  to  Dr.  Edward  Miller  of  that  town. 
In  Xew  London  he  devoted  special  attention  to  diseases 
of  the  eye,  and  in  1817  established  there  the  first  eye  in- 
firmary in  this  country.  According  to  information  fur- 
nished me  by  Dr.  Walter  E.  Steiner,  of  Hartford,  Conn., 
Dr.  Xorth  in  1829  published  a  book  entitled  "The 
Science  of  Life."^  In  it  he  refers  to  his  work  and  insti- 
tution as  follows :  "We  had  attended  to  eye  patients  be- 
fore that  time  (1817),  but  it  occurred  to  us  then  that 
we  might  multiply  the  number  of  cases  of  that  descrip- 


ELISHA    NORTH    (1771-1843), 


OPHTHALMOLOGY  IN  AMERICA.  53 

tion  and  hereby  increase  our  knowledge,  advertising  the 
public  in  regard  to  an  eye  institution.  This  was  done, 
and  we  succeeded,  although  not  to  our  wislies  in  a  pe- 
cuniar}' view  of  the  case.  Our  success  or  exertions  prob- 
ably hastened  in  this  country  the  establishment  of  larger 
and  better  eye  infirmaries  (i.  e.,  for  larger  cities)."  Lit- 
tle is  really  known  of  Dr.  Xorth's  institution  or  his  oph- 
thalmic practice,  but  the  fact  .that  he  was  thus  interested 
in  ophthalmology  is  worthy  of  record  here. 

Philip  Syxg  Physick. — In  making  special  note  of 
the  earh'  general  surgeons  wlio  should  be  remembered 
in  connection  with  the  development  of  ophthalmology 
the  name  of  Philip  Syng  Physick  should,  perhaps,  come 
first.  He  Avas  born  in  Philadelphia  in  1768  and  died 
there  in  1837.  He  received  a  collegiate  education  from 
the  University  of  Pennsylvania,  where  he  graduated  in 
arts  in  1785.  He  studied  medicine  with  a  physician  in 
his  native  town  for  three  years,  and  went  to  London  in 
1789,  where  he  became  the  private  pupil  of  John  Hun- 
ter, with  whose  family  he  lived.  He  was  a  great  favorite 
of  Hunter,  and  received  many  attentions  and  consider- 
ations from  him.  It  was  through  Hunter's  influence 
that  he  was  appointed  to  the  house  staff  of  St.  George's 
Hospital,  London,  in  1790.  In  1791  he  went  to  Edin- 
burgh, and  in  1792,  after  one  course  of  study  in  the 
University  of  Edinburgh,  he  graduated  in  medicine. 
He  then  returned  to  Philadelphia  and  began  practice 
under  most  favorable  conditions.  In  1194  he  was  ap- 
pointed surgeon  to  the  Pennsylvania  Hospital,  which  he 
served  for  many  years.  In  1800  he  was  taken  into  tlie 
medical  department  of  the  L^niversity  of  Pennsylvania, 
first  as  lecturer,  and  in  1805  as  professor  of  surgery.     In 


o4  OPHTHALMOLOGY  IX  AMERICA. 

1818  he  was  transferred  to  the  chair  of  anatomy,  which 
he  occupied  till  1830. 

Dr.  Physick  is  said  to  have  been  a  man  of  medium 
height,  with  '"irdle  classic  features/'  reserved  and  rather 
forbidding  in  his  manner,  pessimistic  in  his  tempera- 
ment, and  devoid  of  the  sense  of  humor.  In  his  teach- 
ing he  was  precise  and  emphatic  and  commanded  the 
profoundest  deference  from  his  pupils.  He  was  not  a 
ready  speaker,  and  for  the  most  part  read  his  lectures 
to  his  classes.  As  a  surgeon  he  was  skilful  and  accurate 
in  operating,  and  always  conservative.  He  was  not  a 
"man  of  books,"  neither  writing  much  nor  reading  much. 
Dr.  Gross  has  said  of  him  that  he  had  no  books  worth 
mentioning,  either  medical  or  non-professional.  In  his 
practice  he  was  essentially  an  empiric,  apparently  being 
guided  altogether  by  the  light  of  experience.  He  had 
no  theories  of  his  own,  and  was  intolerant  in  his  teach- 
ing and  practice  of  the  theories  of  others.  He  possessed, 
however,  one  of  the  richest  endowments  of  a  profes- 
sional man,  namely,  strong  common  sense,  and  this  was 
his  great  bulwark  in  every  situation.  Although  cold  and 
unsocial,  yet  at  heart  he  was  full  of  sympathy  for  suffer- 
ing humanity. 

It  was  he  who  originated  the  idea  of  the  use  of  animal 
ligatures  as  I  shall  elsewhere  note,  and  he  is  said  to 
have  been  the  first  to  wash  out  the  stomach,  in  cases 
of  poisoning,  with  a  gum-elastic  catheter  and  syringe. 
He  devised  many  new  surgical  appliances  and  instru- 
ments, and  in  many  ways  advanced  surgical  practice. 
He  was  an  expert  operator  on  the  eye,  especially  for  cat- 
aract and  artificial  pupil,  as  is  made  evident  by  Dorsey, 
his  nephew,  in  the  first  volume  of  Dorsey's  ''Elements 


DR.   PHILIP   SYNG   PHYSICK    (1768-1837). 


OPHTHALMOLOGY  IN  AMEBIC  A.  ru 

of  Surgery/'  Among  the  original  devices  of  Dr.  Pliysick 
for  ophtlialmic  operations  is  a  forceps-punch  (see  illus- 
tration) for  removing  a  piece  of  iris  for  artificial  pupil. 
Dr.  Physick  wrote  scarcely  anything  for  publication, 
yet,  fortunately,  his  work  and  memory  have  been  per- 
petuated, at  least  partiall}-,  through  the  writings  of  oth- 
ers, particularly  of  his  distinguished  nephew,  John  Syng 
Dorsey,  and  of  his  son-in-law.  Dr.  Jacob  Eandolph.  Dr. 
Physick's  surgical  originality  and  genius  have  won  for 
him  the  distinction  of  being  regarded  as  "the  father  of 
American  surgery." 


Physick's    punch-forceps   for    making   artificial    pupi 


William  Gibsox,  another  eminent  surgeon  who 
thought  and  acted  for  himself  and  who  contributed  ma- 
terially to  ophthalmologic  knowledge  and  practice,  was 
the  successor  to  Physick  in  the  chair  of  surgery  in  tlie 
University  of  Pennsylvania,  to  which  he  was  called  in 
1819.  He  was  born  in  Baltimore  in  1788  and  died  in 
Savannah,  Ga.,  in  1868.  He  graduated  in  arts  in  1806 
from  Princeton  College  with  high  rank  as  a  classical 
scholar.  He  then  repaired  to  Edinburgh,  where  he 
studied  medicine  under  John  Bell,  graduating  in  medi- 
cine from  the  university  of  that  city  in  1809.  From 
there  he  went  to  London,  where  he  studied  for  some  time 
under  Sir  Charles  Bell.  From  London  Dr.  Gibson  re- 
turned to  Baltimore,  and  was  soon  in  successful  prac- 
tice.   He  was  a])pointed  professor  of  surgery  in  the  med- 


58  OPHTHALMOLOGY  IX  AMERICA. 

ieal  department  of  the  University  of  Maryland  in  1812. 
lie  occupied  this  position  till  he  removed  to  Philadel- 
phia in  1819.  His  connection  with  the  Universit}'  of 
Pennsylvania  continued  until  1855.  when  he  resigned. 
Dr.  Gibson  was  the  first  to  ligate  the  common  iliac  artery 
in  1812,  but  his  greatest  feat,  a  feat  which  made  his 
name  widely  known,  both  in  Europe  and  in  this  coun- 
try, was  the  performance  of  the  Cesarean  section  twice 
on  one  woman,  saving  mother  and  child  in  both  in- 
stances. His  reputation  as  an  expert  operator  extended 
far  and  wide,  and  while  at  times  his  ill  temper  betrayed 
him  into  unkind  expressions,  yet  he  never  failed  to 
command  the  highest  respect  of  most  of  his  confreres. 
He  was  an  able  and  impressive  teacher,  his  character- 
istic qualities  being  clearness,  accuracy  and  earnest- 
ness. He  made  no  pretentions  to  eloquence.  Dr.  Gross 
in  his  sketch  of  him  says :  ^'He  handled  his  knife  with 
great  skill  and  was  one  of  the  foremost  operators  of  his 
day,"  Dr.  Gibson  made  many  contributions  to  the  prac- 
tice and  literature  of  general  surgery  and  some  to  the 
surgery  of  the  eye.  His  most  noted  literary  production  was 
his  ''Institutes  and  Practice  of  Surgery,"  the  first  edi- 
tion of  which  was  published  in  1824.  the  last,  the  eighth, 
in  1850.  The  first  volume  of  this  work  contains  an  ex- 
cellent resume  of  the  diseases  of  the  eye  and  their  treat- 
ment, in  which  is  embodied  the  undoubted  results  of  the 
experience  and  study  of  a  man  versed  in  the  ophthal- 
mology of  his  time.  His  discussion  of  cataract  is  es- 
pecially authoritative.  He  was  the  first  surgeon  to  per- 
form the  operation  for  convergent  strabismus,  which 
was  afterward  made  so  popular  by  Dieffenbach.  Unfor- 
tunately, he  did  not  record  his  operation  in  time  to  re- 


DR.    GEORGE    McCLELLAN     (1796-1847). 


OPHTHALMOLOar    I\    AMU  RICA.  01 

ceive  due  credit  for  priority.  This  subject  is  reviewed 
elsewhere  in  this  i^aper.  I  have  also  detailed  on  other 
])ages  some  of  his  procedures  and  instruments  for  opera- 
tions of  the  eye,  showing  the  originality  and  resource- 
fulness of  his  intellect.  Gibson  will  long  remain  a 
prominent  figure  in  the  history  of  ophthalmology  as  well 
;as  surgery. 

George  McClellax, — As  1  have  in  the  preceding 
pages  briefly  rehearsed  Dr.  George  McClellan's  effort  to 
establish  an  eye  hospital  in  Philadelphia  in  1821,  it 
seems  appropriate  to  add  a  few  words  in  regard  to  the 
man  himself.  He  was  born  in  Woodstock,  Conn.,  in 
1796  and  died  in  Philadelphia  in  1847,  51  years  of 
age,  from  an  ulcerative  perforation  of  the  small  intes- 
tine. He  graduated  in  arts  from  Yale  College  in  1815, 
and  began  the  study  of  medicine  with  Dr.  Thomas  Hub- 
hard,  of  Pomfret,  Conn.  He  afterward  became  the 
pupil  of  the  celebrated  Philadelphia  surgeon.  Dr.  John 
Syng  Dorsey.  He  graduated  in  medicine  from  the  Uni- 
versity of  Pennsylvania  in  1819.  After  receiving  his 
M.D.  degree  he  began  the  practice  of  his  profession  in 
Philadelphia,  where  he  labored  during  the  remainder 
of  his  life.  Immediately  after  hx-ating  in  Philadelphia 
he  began  to  teach  anatomy  aud  surgery,  privately,  and 
his  lecture  room  soon  became  a  rallying  ])oint  for  many 
])upils.  It  may  be  said  that  Dr.  McClellan's  private 
school,  which  grew  into  great  popularity,  was  the  germ 
from  which  the  Jefferson  ^[edical  College  sprang  later. 
In  1825,  with  the  assistance  of  other  Philadelphia  physi- 
cians, particularly  John  Eberle,  he  organized  the  Jef- 
ferson Medical  College,  in  which  he  became  the  professor 
of  surgery,  a  position  which  he  occupied  till  1838,  when 


62  OrHTHALMULOGY  IX  AiJtRICA. 

he  was  compelled  to  withdraw.  Immediately  after  this 
change  he,  with  others,  founded  the  medical  department 
of  the  Pennsylvania  College  of  Gettysburg  m  1839.  The 
department  was  closed,  however,  after  four  annual 
courses  of  lectures,  and  he  then  retired  to  private  prac- 
tice. 

Dr.  ^IcClellan  as  a  young  man  was  aspiring  and  ag- 
gressive, and  both  in  the  "Institution  for  Diseases  of  the 
Eye"  and  in  the  Jefferson  Medical  College  he  was.  as 
Dr.  Gross  says,  the  "master  genius."  His  teaching  in 
the  medical  college  included  both  anatomy  and  surgery, 
and  his  vivacity  and  fluency  of  speech  attracted  large 
classes.  His  lectures  were  ''extemporaneous"  and  they 
achieved  a  popularity  and  produced  an  effect  seldom 
equaled.  He  was  full  of  energy  and  enthusiasm,  but 
utterly  without  system.  Every  student  was  strongly 
attracted  to  him.  and  "Mac*'  was  the  name  liy  which  he 
was  generally  designated.  As  an  operator  he  was  showy 
and  at  times  brilliant.  Ijut  it  was  claimed  by  his  adherents 
that  he  lacked  judgment  and  patience.  McClellan  wrote 
and  published  very  little.  A  posthumous  work  on  the 
"Principles  and  Practice  of  Surgery"  was  published  by 
his  son.  the  late  Dr.  John  H.  B.  McClellan,  which,  how- 
ever, attracted  indifferent  attention.  I  have  already 
sho^vIl  that  Dr.  ]kIcClellan  was  especially  interested  in 
ocular  surgery,  and  no  doubt  this  interest  was  lessened 
only  by  being  overshadowed  by  that  in  general  surgery  It 
appears  that  he  had  similar  "troubles  and  tribulations." 
however,  in  this  branch  of  surgical  art  to  those  which 
frequently  befall  ophthalmologists  and  surgeons  of  the 
present  day.  for  in  1828  a  suit  for  malpractice  was 
brought  against  him  on  account  of  alleged  want  of  skill 


DR.  JOHN  KEARNEY  RODGERS    (1793-1851). 


OPHTHALMOLOGY  IN  AMERICA.  65 

in  a  case  of  cataract,  in  which  a  verdict  of  $500  was 
rendered  in  favor  of  the  plaintiff.  Dr.  Gross  has  re- 
minded ns  that  "the  suit,  as  most  frequently  happens, 
had  been  instigated  by  professional  enemies."  Notwith- 
standing the  criticisms  and  inuendos  which  his  enemies 
in  the  profession  saw  fit  to  make,  he  was  recognized  as 
a  practical  surgeon  of  high  rank.  The  school  which 
he  founded  has  contributed  through  its  graduates  many 
eminent  surgeons  and  teachers.  He  is  also  to  be  re- 
membered as  the  father  of  Gen.  George  B.  McClellan. 
of  Civil  War  fame,  and  grandfather  of  George  B. 
McClellan^  the  present  mayor  of  the  city  of  Xew  York. 
JoHx  Keakxey  Eodgeks  was  born  in  'New  York  City 
in  1793  and  died  there  in  1851,  his  death  being  caused  by 
"phlebitis  of  the  liver  followed  by  peritonitis."  He  ob- 
tained his  classical  education  at  Princeton  College,  and 
afterward  studied  medicine  under  Dr.  Wright  Post,  who 
was  a  distinguished  Xew  York  surgeon.  He  graduated 
from  the  College  of  Physicians  and  Surgeons  in  1816. 
After  his  graduation  he  and  Dr.  Edward  Delafield  went 
to  London,  where  they  pursued  their  studies  at  the  hos- 
pitals of  that  city  under  the  famous  masters  of  the  me- 
tropolis, giving  special  attention  to  diseases  of  the  eye. 
In  1818;  soon  after  his  return  to  New  York,  Dr.  Rod- 
gers  was  appointed  demonstrator  of  anatomy  in  the  col- 
lege from  which  he  graduated.  Four  years  afterward 
he  was  made  surgeon  to  the  New  York  Hospital,  an 
office  which  he  much  coveted  and  which  he  retained  up 
to  the  time  of  his  death — a  period  of  thirty  years.  He 
was  a  practitioner  of  great  eminence,  and  with  Dr. 
Delafield,  was  the  founder  of  the  New  York  Eye  In- 
firmary, in  1820,  which  ijistitution  he  served  for  many 


60  OPHTHALMOLOGY  IX  AMERICA. 

years.  He  was  especially  noted  for  his  sterling  integ- 
rity, his  active  and  generous  mind,  and  for  his  adroit- 
ness and  ease  as  an  operator.  It  has  been  said  that  as 
an  operator  he  had  no  superior  in  this  country,  except, 
perhaps,  Valentine  Mott,  who  so  long  wielded  the  scep- 
ter on  the  American  continent.  The  principal  opera- 
tion which  gave  him  great  honor  throughout  the  sur- 
gical world,  and  for  all  time,  was  the  ligation  of  the  left 
subclavian  artery  within  the  scaleni  muscles,  in  18-45. 
on  account  of  a  large  aneurism  of  that  vessel,  a  feat 
which  up  to  that  time  was  universally  regarded  as  im- 
practicable. In  consultations  he  was  the  wise  counselor. 
and  under  all  circumstances  he  was  the  sympathizing 
and  trusted  friend  and  physician.  His  contributions  to 
medical  literature  were  not  numerous,  and  it  is  to  be  re- 
gretted that  the  record  of  his  vast  experience  has  been  so 
insuflficieut.  Meager  as  his  contributions  were  they,  how- 
ever, leave  a  mark  which  will  not  be  easily  erased. 

I^DWARD  Delafield  was  during  his  whole  life  a  prom- 
inent figure  in  Xew  York  professional  circles.  He  was 
energetic,  skilful  and  courteous  and  occupied  many  posi- 
tions of  trust.  He  had  a  very  large  practice,  and  was 
for  a  long  time  professor  of  obstetrics  and  diseases  of 
women  and  children  in  the  College  of  Physicians  and 
Surgeons.  He  was  born  in  1795  and  died  in  1875.  He 
graduated  in  arts  at  Yale  College  in  1812  and  in  medi- 
cine at  the  College  of  Physicians  and  Surgeons  of  Xew 
York  in  1815.  After  a  period  of  service  as  interne  in 
the  Xew  York  Hospital,  he  and  Dr.  John  Kearney  Eodg- 
ers  went  to  Europe  for  special  study.  Soon  after  re- 
turning Dr.  Delafield,  with  Dr.  Eodgers,  organized  the 
Xew  York  Eye  Infirmary  in  1820,  as  above  detailed. 


DR.  EDWARD  DELAFIELD   (ITO^-lSTo) . 


OPHTHALMOLOGY  IN  AMERICA.  69 

He  acted  as  surgeon  and  gave  clinical  lectures  there  on 
diseases  of  the  eye  for  many  years.  He  was  one  of 
the  active  promoters  of  the  organization  of  the  Ameri- 
can Ophthalmological  Society  in  1864  and  was  unani- 
mously elected  its  first  president,  a  fitting  acknowledge- 
ment of  what  he  had  done  by  his  example  and  labors 
during  many  years  to  make  ophthalmology  an  honor- 
able department  of  medical  practice  in  the  estimation 
of  the  public  and  profession.  Clinical  teaching  at  the 
New  York  Eye  Infirmary  was  early  instituted  by  Dr. 
Delafield  and  was  carried  on  by  himself  and  associates 
for  many  years.  He  wrote  and  published  very  little. 
His  ophthalmologic  writings  were  chiefly  reports  of  ex- 
periences from  his  practice  in  the  infirmary,  a  few  of 
which  will  be  found  in  the  early  transactions  of  the  Oph- 
thalmological Society,  and  his  notes  to  his  American 
edition  of  "Travers  on  the  Eye/'  to  be  referred  to  later. 
Dr.  Edward  Eeyxolds  was  born  in  Boston,  Mass., 
in  February,  1793,  and  there  closed  his  long  life  in 
1881.  He  graduated  in  arts  at  Harvard  College  in  1811, 
and  afterward  for  several  years  was  a  private  pupil  in 
medicine  of  Dr.  John  Collins  Warren.  He  then  availed 
himself  of  the  very  great  advantage  of  three  years  of 
training  abroad.  In  London  he  studied  under  Aber- 
nethy  and  Astley  Cooper,  and  at  Paris  with  Bichat  and 
Dupuytren.  He  also  followed,  at  London,  the  lectures 
of  Sir  William  Lawrence  on  diseases  of  the  eye,  and 
with  his  fellow-students  was  carefully  taught,  among 
other  things,  to  perform  ophthalmic  operations,  using 
sheep's  eyes  set  in  a  mask.  It  was  perhaps  owing  to  the 
influence  of  his  European  teachers  that  he  acquired  a 
preference   for   surgery,   and   especially   for   ophthalmic 


70  OPHTHALilOLOGY  IX  AMEIilCA. 

surgery,  although  lie  always  enjoyed  an  extensive  gen- 
eral practice.  During  Dr.  Eeynolcl's  lifetime  modern 
specialization  of  the  medical  profession  was  not  known, 
and  he  never  lost  his  interest  in  the  pursuit  of  gen- 
eral professional  work. 

After  returning  from  abroad,  he  found  his  father,  at 
00  years  of  age.  blind  with  cataracts  in  both  eyes.  He 
had  the  rare  courage  to  perform  the  depression  of  the 
two  lenses  at  one  sitting.  Happily  the  operation  proved 
a  complete  success.  It  had  never'  before  been  under- 
taken in  Boston  and,  becoming  widely  known,  formed 
the  foundation  for  a  reputation  which  made  him  the 
leading  surgeon  in  diseases  of  the  eye  in  Boston  and 
throughout  Xew  England  for  many  years. 

In  182-i  he  and  Dr.  John  Jeffries,  son  of  the  fa- 
mous aeronaut  and  man  of  science  of  that  name,  es- 
tablished a  dispensary  whicli  developed  into  the  well- 
known  Massachusetts  Charitable  Eye  and  Ear  Infirmary 
above  referred  to.  After  the  withdrawal  of  Dr.  Jef- 
fries, Dr.  Eeynolds  long  continued  to  be  the  senior  sur- 
geon of  the  infirmary,  training  for  it  a  staff  of  able 
men,  devoted  to  ophthalmic  practice.  His  connection 
with  the  institution,  first  as  surgeon  and  later  as  teacher, 
lasted  until  1870,  but  his  interests  in  it  continued  un- 
abated to  the  end  of  his  days. 

He  was  one  of  the  founders  of  the  well  remembered 
Tremont  Medical  School,  and  was  for  many  years  its 
professor  of  general  surgery.  During  a  prolonged  ab- 
sence of  Dr.  Warren  in  Europe  he  also  taught  anatomy 
and  surgery  at  the  Harvard  ^Medical  School.  As  an 
eye  surgeon  his  fame  was  such  that  in  1864.  on  the  or- 
ganization of  the  American  Ophthalmological  Society, 
he  was  made  an  honorarv  member. 


DR.  EHDWARD  REYNOLDS    (1793-1881), 


DR.    JOHN   JEFFRIES    (1796-187G). 


OPHTHALMOLOGY  IN  AMERICA.  75 

Physically  he  was  a  giant  among  men.  His  fine  and 
commanding  presence,  his  always  genial  humor,  and  the 
ready  generosity  of  his  character  made  for  him  a  host  of 
friends  and  followers  in  his  community.  There  was 
an  entire  absence  of  professional  jealousy  in  him,  and 
he  was  as  kind  as  he  was  unselfish.  He  lived  to  be  for 
many  years  the  Xestor  of  the  local  profession  and,  except 
for  an  increasing  deafness,  retained  all  his  faculties  and 
capacity  for  the  enjoyment  of  life  to  within  a  few 
months  of  his  death,  which  occurred  at  the  end  of  his. 
eighty-ninth  year.* 

John  Jeffries,  who  with  Dr.  Edward  Reynolds,. 
founded  the  Massachusetts  Charitable  Eye  and  Ear  In- 
firmary, was  born  in  Boston  in  1796  and  died  in  1876. 
He  was  the  son  of  a  distinguished  surgeon  of  revolu- 
tionary times,  Dr.  John  Jeffries.  In  1815  he  graduated 
in  arts  from  Harvard  College,  and  in  1819  received  from 
the  same  institution  the  degree  of  doctor  of  medicine. 
He  was  one  of  Boston's  most  distinguished  practitioners, 
and  from  the  foundation  of  the  Massachusetts  Chari- 
table Eye  and  Ear  Infirmary  in  1824  until  1841  he  was 
one  of  its  surgeons.  While  he  was  recognized  only  as  a 
general  practitioner,  his  ophthalmologic  practice,  never- 
theless, was  large.  He  was  universally  respected  and 
beloved  as  a  citizen  and  as  a  physician. 

Horatio  Gates  Jameson  was  an  early  Baltimore 
surgeon  whose  work  included  the  treatment  of  diseases 
of  the  eye.  He  was  born  in  York,  Pa.,  in  1788,  and 
died  in  Baltimore  in  1855.  He  graduated  in  medicine 
from  the  I'niversity  of  Maryland  in  1813,  and  imme- 

*  From  information  kindly  furnished  me  by  his  grandson.  Dr. 
Edward  Reynolds,  of  Boston,  and  to  whom  also  I  am  indebted  for 
the  accompaning   portrait. 


70  OFHTHALMOLOGY  IX  AMERICA. 

diately  located  in  Baltimore,  where  he  soon  attained 
high  rank  as  a  surgeon  and  physician.  He  was  the 
founder  in  182  T  of  the  Medical  Department  of  Wash- 
ington College  (afterward  the  Washington  University 
School  of  Medicine),  Washington,  Pa.,  and  was  its  pro- 
fessor of  surgery  from  the  time  of  its  organization  to 
1835.  Besides  being  a  practical  surgeon,  he  made  numer- 
ous contributions  to  surgical  literature.  Perhaps  one 
of  the  most  important  of  these  was  the  prize  essay  of 
1827,  on  "Observations  upon  Traumatic  Hemorrhage,  Il- 
lustrated by  Experiments  upon  Living  Animals/'  in 
which  he  demonstrated  anew  the  use  and  value  of  animal 
ligatures.  His  teaching,  however,  on  this  subject,  al- 
though sustained  by  the  authority  of  Dr.  Physick,  was 
not  aj^preciated  by  contemporary  surgeons,  and  it  was 
forgotten  until  after  the  method  became  popular  as  one 
of  the  features  of  antiseptic  surgery. 

Jameson,  besides  being  an  excellent  surgeon,  was  also 
a  journalist  of  considerable  note  and  was  the  author 
of  several  books  and  papers  on  medical  subjects  which 
received  high  commendation. 

Although  a  distinguished  general  surgeon  and  prac- 
titioner, it  is  his  contributions  to  early  American  opli- 
thalmolog}'  that  especially  concern  us  here,  as  he  ap- 
pears to  have  been  much  interested  in  diseases  of  the 
eye.  He  undoubtedly  included  them  in  his  surgical 
practice  and  teaching  and  wrote  some  instructive  pa- 
pers pertaining  to  them.  Dr.  Harry  Friedenwald^"  cites 
some  of  them  which  were  published  in  Jameson's  owe 
journal,  The  Maryland  Medical  Becorder.     One  was  on 

10.  The  Early  History  of  Ophthalmology  and  Otology  in  Balti- 
more (1800-18.50),  .Johns  Hopkins  Hospital  Bulletin,  August-Sep- 
tember. IS'.iT. 


OPHTHALMOLOGY  IN  AMERICA.  77 

the  "Pathological  Sympathy  between  the  Eye  and  the 
Larynx  ;"^^  another  was  on  "A  Case  of  Enlargement  of 
the  Eye  Following  the  Entrance  of  Steel  into  the  Eye."^- 
probably  panophthalmia;  another  was  one  describing 
"Two  Cases  of  Ossification  of  the  Lens  with  Luxation 
Through  the  Pupil/'^^  and  another  was  on  "Amaurosis 
Associated  with  Inordinate  Thirst/'^^  He  also  pub- 
lished^^ another  paper  giving  an  account  of  the  success- 
ful removal  of  "An  Encysted  Tumor  of  the  Orbit." 

John  Mason  Gibson  was  another  Baltimore  man 
who  aspired  to  do  ophthalmologic  work  and  evidently 
to  make  it  an  exclusive  practice.  He  was  admitted  into 
the  "Faculty"  of  Maryland  in  1825.  Very  little  is  re- 
corded of  his  life,  but  his  ambition  was  made  apparent 
by  the  publication  of  a  book  entitled  "Condensation  of 
Matter  upon  the  Anatomy,  Surgical  Operations  and 
Treatment  of  Diseases  of  the  Eye,"  in  1832.  I  shall 
refer  to  this  book  elsewhere. 

John  Harper. — Still  another  surgeon  of  Baltimore 

was  John  Harper   ( 1831).     He  is  mentioned  by 

Dr.  Harry  Friedenwald  and  also  by  Dr.  R.  M.  Reese 
in  his  American  edition  of  "Cooper's  Dictionary  of  Prac- 
tical Surgery"  as  one  of  the  most  successful  surgeons  in 
this  country.  He  was  a  native  of  Ireland  and  graduated 
at  Glasgow.  He  died  in  Baltimore  in  1831.  The  Mary- 
land Medical  Recorder  (vol.  ii,  p.  179)  refers  to  him  as 
"well-known  as  an  oculist."  He  was  one  of  the  early 
surgeons  who,  according  to  Dr.  Reese,^^  operated  fre- 

11.  Maryland  Med.   Recorder,   1831,  ii,   117. 

12.  Ibid.,  p.  601. 

13.  Ibid.,  p.  6'08. 

14.  Ibid.,  p.  664. 

15.  The  American  Medical  Recorder  of  Philadelphia,  xii,  340. 

16.  Cooper's  Surg.  Dictionary,  1842,  i,  272. 


78  OPHTHALMOLOGY  IX  AMERICA. 

quently  for  cataract.  He  seldom  adopted  any  other 
operation  for  it  than  the  laceration  of  the  capsule  and 
lens  substance,  repeated  "as  often  as  necessary  on  the 
same  eye/*' 

Xathax  E.  Smith  was  another  notable  Baltimore 
surgeon  and  teacher  who  was  also  eminent  as  an  ophthal- 
mic surgeon.  He  was  born  in  Concord,  X.  H.,  in  1T97 
and  died  in  Baltimore  in  188 T.  He  was  the  son  of 
the  great  physician  and  surgeon,  Xathan  Smith,  of 
New  Haven,  and  received  both  his  classical  and  medical 
education  at  Yale,  in  which  his  father  was  one  of  the 
professors.  He  graduated  in  medicine  from  that  insti- 
tution in  1823.  Dr.  Smith  was  successively  attached  to 
medical  schools  in  Philadelphia,  Lexington,  Ky.,  and 
Baltimore,  the  principal  part  of  his  professional  career 
having  been  spent  in  the  last  mentioned  city.  He  had  an 
inventive  mind  and  added  considerably  to  the  instru- 
mental and  operative  improvements  of  both  surgery  and 
ophthalmolog}'.  Some  of  his  ophthalmologic  instru- 
ments will  be  referred  to  later.  Dr.  Smith  was  the 
grandfather  of  our  distinguished  colleague.  Dr.  Samuel 
Theobald  of  Baltimore. 

Samuel  D.  Gross. — It  would  be  quite  unjust  to  limit 
my  references  entirely  to  those  whom  I  have  already 
considered.  Certain  other  surgeons  of  a  little  later 
period  were  so  active  in  this  department  of  practice  that 
some  mention  should  be  made  of  them  also.  I  wish 
first  to  take  note  of  Samuel  D.  Gross,  who  was  not  only 
one  of  the  greatest  surgeons  of  his  time,  but  practiced 
ophthalmolog}'  and  contributed  to  ophthalmologic  liter- 
ature from  the  earliest  periods  of  his  professional  life 
almost  to  the  time  of  his  death.     In  fact,  at  the  time  of 


DR.   NATHAN  R.    SMITH    (1797-1887), 


DR.  SAMUEL  D.  GROSS    (1805-1884). 


OPHTHALMOLOGY  IN  AMERICA.  83 

his  graduation  his  thesis  had  for  its  subject  "The  Nature 
and  Treatment  of  Cataract,"  to  the  composition  of  which 
he  devoted  unusual  care  and  labor.    In  his  autobiography 
(vol.  i,  p.  39)  he  says:    "I  had  seen  many  cases  of  this 
disorder  during  my  Philadelphia  pupilage.^^     It   is  a 
subject  which  during  my  prolonged  professional  life  has 
deeply  interested  me."     So  prominent  was  he  in  ocular 
surgery  at  the  close  of  the  first  half  of  the  nineteenth 
century  that  he  was  elected  one  of  the  delegates  from  the 
United  States  to  the  first  international  ophthalmologic 
congress,  held  in  Paris  in  1857,  and  contributed  to  it  an 
important  paper  in  regard  to  the  prevailing  eye  diseases 
of  this  country.    He  was  also  one  of  the  first  to  operate 
for  strasbismus,  and  he  wrote  a  valuable  paper  on  the 
subject,  which  was  published  in  the  Western  Journal  of 
Medicine  and  Surgery  in  1842.   One  of  his  cotemporaries 
said  that  this  article  ''abounded  in  discriminating  criti- 
cisms on  popular  errors  on  the  subject  and  furnished  the 
best  statistics  on  the  subject  anywhere  to  be  found."^^ 

-Dr.  Gross  was  born  in  1805  and  died  in  1884.  He 
was  a  student  of  medicine  of  the  celebrated  Dr.  George 
McClellan,  to  whom  I  have  already  made  reference,  and 
graduated  from  the  Jefferson  Medical  College  in  1828. 
The  first  period  of  his  career  was  in  the  then  West  (Cin- 
cinnati and  Louisville).  He  finally  took  up  his  resi- 
dence in  Philadelphia,  and  in  1856  was  made  professor 
of  surgery  in  the  college  from  which  he  received  his 
medical  degree.  He  was  a  voluminous  writer,  but  one 
of  the  most  charming,  clear  and  systematic  of  medical 
authors.     He  will,  of  course,  be  especially  remembered 

17.  Probably  under  Dr.  McClellan. 

18.  Dr.    Reese    in    Cooper's    Surgical   Dictionary,    Am.    Ed.,    1842, 
p.  128  of  supplement. 


84  OPHTHALMOLOGY  IN  AMERICA. 

for  his  "System  of  Surgen-/'  the  first  edition  of  which 
appeared  in  1859.  A  man  of  his  versatility,  of  his  sur- 
gical Judgment  and  skill  and  of  his  diversified  practice 
will  never  be  forgotten  ;  and,  inasmuch  as  he  was  so 
distinguished  in  ophthalmologic  practice,  our  own  "cult" 
should  show  him  special  homage. 

Alfred  C.  Post. — Still  another  practitioner  who  con- 
tributed to  the  advancement  of  ocular  surgery  was 
Alfred  C.  Post,  who  lived  and  practiced  in  Xew  York 
City.  He  was  born  in  1806  and  died  in  1886.  He  grad- 
uated in  arts  from  Columbia  College  in  1822  and  from 
the  College  of  Physicians  and  Surgeons  in  medicine  in 
1827.  He  afterward  continued  his  medical  studies  in 
Paris,  Berlin,  Vienna  and  London,  returning  to  New 
York  in  1829,  where  he  began  the  practice  of  surgery. 
As  a  teacher  of  surgery  he  served  first  the  College  of 
Physicians  and  Surgeons,  and  afterward  the  Medical  De- 
partment of  the  University  of  the  City  of  Xew  York.  As 
a  surgeon  he  was  attached,  at  different  times,  to  the  New 
York  Hospital,  the  Presbyterian  Hospital,  St.  Luke's 
Hospital  and  others.  He  achieved  great  fame  in  sur- 
gery, being  noted  for  precision  and  dexterity  in  his 
operations.  He  also  exercised  much  mechanical  inge- 
nuity in  devising  instruments  and  methods  of  operating, 
laboring  particularly  to  improve  plastic  surgery,  both 
generally  and  in  the  region  of  the  eye.  His  first  case 
of  blepharoplasty  was  reported  as  early  as  1842.  in  a  pa- 
per entitled  "Blepharoplastic  Operations  for  the  Cure 
of  an  Aggravated  Case  of  Ectropion."^^  He  also  read  an 
important  paper  on  the  same  subject  before  the  American 

19.   New  York  Medical  Gazette,  vol.  ii.  1S42,  p.  23. 


DR.  ALFRED  C.  POST   (180G-18S6), 


DR.  JOHN  II.  DIX   (1813-1884). 


OPHTHALMOLOGY   IN    AMERICA.  89 

Medical  Association  in  1878.-*^  His  deep  interest  in 
ocular  surgery  was  manifest  on  various  occasions  and 
should  not  be  forgotten.  His  principal  writings  were 
published  in  medical  periodicals,  with  the  exception  of 
a  small  volume  on  strasbismus,  which  was  issued  in  1841. 
Dr.  Post  was  the  son  of  Joel  Post  and  was  born  in  Xew 
York,  where  he  lived  during  his  whole  life. 

John"  H.  Dix. — Belonging  to  this  period  was  John  H. 
Dix.  He  was  born  in  Boston  in  1813  and  died  there  in 
1884.  He  graduated  in  arts  from  Harvard  College  in 
1833,  and  in  medicine  from  Jefferson  Medical  College, 
Philadelphia,  in  1836.  He  at  once  began  the  practice  of 
medicine  in  his  native  town,  giving  especial  attention 
to  diseases  of  the  eye.  In  1846  he  visited  Europe,  where 
he  continued  his  study  of  this  subject.  At  home  he  was 
one  of  the  most  active  workers  in  that  field,  and  was  a 
frequent  contributor  to  the  ophthalmologic  literature  of 
his  time.  He  was  always  alert  to  the  latest  discoveries 
and  was  the  first- ^  in  America  to  follow  the  example  of 
Dieffenbach  in  the  operation  for  strabismus,  reporting 
his  case  in  September,  1840.  He  again  operated  Oct.  16, 
1840,  in  the  presence  of  Drs.  Reynolds,  Jeffries,  Hooper, 
Bethune  and  Charles  Ware.-^  He  is  said  to  have  been 
a  skilful  operator  and  a  very  close  and  discriminating 
observer. 

D.  Hayes  Agnew. — Only  a  brief  sketch  can  be  given 
here  of  this  great  surgeon,  although,  like  others  to  whom 
I  have  similarly  referred,  he  is  worthy  of  a  more  de- 
tailed presentation  and  study.     He  came  into  surgical 

20.  Transactions  of  the  American  Medical  Association,  vol.  xxxix, 
1878,  p.  353. 

21.  Boston  Medical  and  Surgical  Journal,  Sept.  30,  1840. 

22.  Medical  Examiner,  Philadelphia.  1840,  iii.  7G0. 


90  OPHTHALMOLOGY  IX  AMERICA. 

prominence  soon  after  Dr.  S.  D.  Gross  had  risen  to  his 
zenith.  He.  too^  i^racticed  ophthalmolog}-  in  connection 
with  general  surgery.  He  was  born  in  Nobleville  (now 
Christiana),  Lancaster  Counts-,  Pa.,  in  1818,  and  died 
in  Philadelphia  in  1892.  His  father  was  a  physician 
of  local  renown  and  belonged  to  the  family  of  Agnews, 
who  have  been  more  or  less  distinguished  both  in  Europe 
and  America  since  the  Xorman  conquest  of  England. 
Young  Agnew  received  a  good  classical  education,  al- 
though he  never  took  a  degree  in  arts.  He  studied  med- 
icine with  his  father,  and  in  1836  entered  the  Medical 
Department  of  the  University  of  Pennsylvania,  from 
which  he  graduated  in  1838.  He  then  returned  home 
and  for  five  years  practiced  with  his  father,  after  which 
he  endeavored  to  establish  himself  elsewhere  in  different 
places,  but  without  success.  Between  the  A-ears  18-14 
and  1847  he  undertook  a  business  enterprise,  which  re- 
sulted in  failure.  He  then  returned  again  to  the  prac- 
tice of  his  profession,  first  in  the  country  and  afterward 
in  Philadelphia.  He  removed  to  that  cit}'  in  1848  and 
at  once  began  a  career  of  teaching  and  practice  which 
culminated  in  his  being  one  of  the  most  famous  sur- 
geons in  the  United  States.  It  would  be  untimely  for 
me  to  take  note  of  the  various  steps  which  led  up  to  such 
renown.  In  a  general  way  I  may  say  that  his  profes- 
sional relations  to  hospitals  were  numerous.  His  pop- 
ularit}'  as  a  teacher,  both  in  his  private  schools  and  in 
the  University  of  Pennsylvania,  was  unrivaled.  As  a 
writer  he  contributed  many  papers  and  monographs  to 
the  literature  of  surgery  of  much  value.  The  great 
work,  however,  of  his  life  and  that  which  will  stand  as 
an  enduring  monument  to  his  memory  was  the  "Prin- 


DR.    D.    HAYES    AGNEW    (1818-1892). 


OPHTHALMOLOGY  IN  AMERICA.  93 

ciples  and  Practice  of  Surger}-/^  in  three  volumes,  the 
first  being  published  in  1878  and  the  last  in  1883. 
Immediately  after  its  publication  Dr.  Gross  was  asked 
what  he  thought  of  it,  and  in  his  impressive  style 
he  said :  "I  sat  up  nearly  the  whole  of  the  night 
before  last  reading  this  work,  and  I  will  venture  to  as- 
sert that  '^Agnew's  Surgery'  will  be  read  and  consulted 
by  the  medical  world  long  after  the  dust  has  settled  for- 
ever on  the  covers  of  similar  works."  To  an  added  in- 
quiry, "How  do  you  think  it  compares  with  your  own 
work  ?''  Dr.  Gross  modestly  replied :  "Why,  sir,  mine 
is  in  comparison  a  pigmy."  In  a  letter  to  Dr.  Agnew 
later  Dr.  Gross  said :  "You  have  produced  a  great  and 
noble  work,  one  creditable  alike  to  yourself,  your  pro- 
fession and  your  country."  The  subject  of  diseases  of 
the  eye  was  carefully  and  fully  considered,  and  the  sec- 
tion devoted  to  it  gives  ample  evidence  of  the  author's 
familiarity  with  it.    It  is  a  most  creditable  production. 

Dr.  Agnew's  personality  was  impressive  and  attrac- 
tive. He  was  tall,  like  his  ancestors.  It  is  said  that 
his  father,  who  was  the  shortest  of  seven  brothers,  had 
a  height  of  six  feet  and  two  inches,  the  tallest  of  the 
seven  being  six  feet  and  seven  inches.  As  a  man  and 
2)hysician  (and  he  practiced  "internal  medicine"  as  well 
as  surgery  to  the  end  of  his  life)  he  was  greatly  honored. 
He  was  never  morose,  never  discouraged,  always  calm 
exteriorly.  xHthough  reticent  and  undemonstrative,  he 
was  always  cheerful.  He  had  no  jealousies  and  was  ever 
ready  to  assist  the  weak  and  struggling  practitioner. 
He  did  not  attain  his  preeminent  position  in  surgery 
suddenly.      The   first   fifteen   years   of   his   professional 


94  OPHTHALMOLOGY  IX  AMERICA. 

life  seemed  to  him  fruitless  and  unsatisfactory,  but  by 
patient  industry  and  tireless  application,  wise  judgment, 
thorough  knowledge,  consummate  skill,  honest  purpose 
of  word  and  act,  he  rose  to  a  distinction  in  the  profes- 
sion seldom  attained. 

Dr.  Agnew  took  great  interest  in  ophthalmic  surgery 
and  was  one  of  the  surgeons  to  Wills  Eye  Hospital  from 
1864  to  1868.  He  was  an  expert  operator  on  the  eye. 
and  his  thorough  knowledge  of  the  subject  is  made  evi- 
dent by  the  manner  in  which  he  has  presented  it  in  his 
"Surgery."' 

WiLLiAiNi  Clay  Wallace. — A  man  who  will  long  be 
remembered,  not  for  his  eminence  in  the  profession, 
but  for  a  work  on  the  comparative  anatomy  of  the  eye. 
and  especially  of  the  ciliary  muscle  of  that  organ,  includ- 
ing its  physiology,  is  William  Clay  Wallace  of  Xew  York 
City,  who  st}ied  himself  "oculist.''  It  is  because  of  Dr. 
Wallace's  work  on  the  ciliary  muscle,  which  included 
original  and  careful  dissections,  and  his  theory  of  the 
accommodation  of  vision  to  different  distances,  that  I 
hereby  refer  to  his  name.  I  am,  however,  unable  to  ob- 
tain a  sketch  of  his  life.  I  shall  refer  to  his  work  in 
another  connection. 

That  Dr.  Wallace  had  a  recognized  standing  is  proved 
by  the  fact  that  Dr.  Eeese  included  him  in  his  list  of 
American  surgeons  who  were  his  collaborators  in  pro- 
ducing the  American  edition  of  "Cooper's  Surgical  Dic- 
tionary" in  1842. 

Mr.  Hexry  Howard — In  the  history  of  the  ophthal- 
molog}'  of  Montreal  I  find  one  man  who  early  undertook 
to  limit  his  practice  exclusively  to  the  treatment  of  dis- 


OPHTHALMOLOGY  IN  AMERICA.  95 

eases  of  the  eye.  This  man  was  :\Ir.  Henry  Howard.  He 
studied  this  subject  undoubtedly  with  a  great  deal  of 
care  under  the  instruction  of  the  distinguished  Professor 
Arthur  Jacob  of  Dublin  Ireland,  and  he  was  found  en- 
gaged in  this  special  joractice  in  Montreal  for  several 
years  beoinnino-  in  184G. 


IV. 

THE    AM  ERIC  AX    LITERATURE    OX    OPHTHALMOLOGY 

DURING   THE   FIRST   HALF   OF  THE   XIXE- 

TEEXTH   CEXTURY. 

The  books  that  were  published  during  this  period  by 
American  authors  were  few  and  their  merits  varied. 
Some  were  excellent  both  in  subject  matter  and  style  and 
others  were  inferior.  Several  English  works  were  re- 
published in  this  country  with  the  revisions  and  addi- 
tions of  our  best  men.  I  will  speak  of  this  literature 
very  briefly. 

THE  FIRST  AMERICAX   BOOK  OX  DISEASES  OF   THE  EYE. 

The  first  American  book  on  ophthalmology  was  that 
of  Dr.  Frick  entitled :  "A  Treatise  on  the  Diseasec>  of  the 
Eye,  Including  the  Doctrines  and  Practice  of  the  Most 
Eminent  Modern  Surgeons,  and  Particularly  those  of 
Professor  Beer.  By  George  Erick,  M.D.,  Ophthalmic 
Surgeon  to  the  Baltimore  General  Dispensary.  With 
an  engraving.    Baltimore  :   Fielding  Lucas,  Jun..  1823." 

This  is  an  octavo  volume  of  xx-320  pages,  with  one 
plate  illustrating  instruments  for  operation  for  cataract. 

The  book  is  a  precious  souvenir  of  the  early  ophthal- 
mology of  America,  first,  because  it  was  the  first  Ameri- 
can treatise  on  diseases  of  the  eye,  and,  second,  because  it 
was  the  production  of  a  young  man  wlio  had  had  un- 
excelled training  and  a  diversified  experience  under  the 
tutelage  of  Dr.  George  Beer  of  Vienna,  the  greatest 
ophthalmologist  that  the  world  had  then  ever  known. 


OPHTHALMOLOGY  IN  AMERICA.  97 

The  author  says  in  the  introduction  that  the  volume  is 
little  more  than  the  abstract  of  a  course  of  lecture? 
which  he  had  prepared  on  diseases  of  the  eye  and  repre- 
sents the  teaching  of  Dr.  Beer,  to  which  "he  has  en- 
deavored to  add  what  he  has  conceived  most  important 
from  the  experience  and  practice  of  others,  together  with 
such  remarks  as  his  own  observations  have  supplied." 

The  arrangement  "is  founded  on  the  variety  of  tex- 
tures which  enter  into  the  structures  or  composition  of 
the  eye,  and  is  comprehended  under  four  general  divi- 
sions. The  first  includes  the  various  forms  of  inflam- 
mation of  the  eye;  the  second  the  effects  of  sequelae  of 
this  inflammation;  the  third  comprehends  the  various 
diseases  of  the  appendages,  and  the  fourth  such  diseases 
as  attack  at  the  same  time  several  or  all  of  the  tissues  of 
the  organ." 

Dr.  Frick  laments  "that  the  pathology  of  the  eye  has 
not  kept  progress  with  the  advanced  state  of  pathologic 
science  in  general,  and  this  is  attributable,  no  doubt,  to 
the  circumstances  that  this  branch  of  the  healing:  art  has 
been  confined  for  so  long  a  time  to  exclusive  oculists," 
and  also  that  diseases  of  the  eye  have  "obtained  but  a 
small  share  of  the  attention  of  the  profession."  The 
work  is  a  model,  from  the  literary  standpoint,  and  is 
clear  and  concise  in  expression. 

I  can  not  dwell  on  the  contents  of  this  book,  but  I 
wish  to  call  particular  attention  to  his  chapter  on  cat- 
aract. After  describing,  with  the  utmost  clearness,  the 
nature  of  cataract  and  the  dift'erent  methods  of  its  treat- 
ment, including  its  extraction  and  absorption,  he  comes 
to  the  following  conclusion  : 


98  OPHTHALMOLOGY  IX  AMERICA. 

We  may  lay  it  down,  as  a  general  rule,  to  extract  in  all  such 
cases  where  the  cataract  occurs  in  a  healthy  subject,  without 
any  complication  of  other  disease,  and  is  of  the  species  denom- 
inated dura,  where  the  eye  remains  firm  and  quiet  under  the 
knife,  where  the  pupil  is  large  and  dilated,  and  where  the 
anterior  chamber  is  large  and  full.  These  are  on  the  whole 
the  most  favorable  cases  for  any  operation,    (p.  214.) 

On  page  175  he  defines  the  most  important  proper- 
ties of  a  good  knife,  and  such  a  knife,  it  seems  to  me, 
would  meet  the  most  refined  requirements  of  those  who 
to-dav  perform  the  flap  operation.  His  description  of 
the  operation  represents  also  the  ideal  of  mechanical 
technic. 

He  says  that  in  extraction  ^'many  circumstances  may 
occur  to  mar  the  success  of  the  operation.  The  most 
important  of  these  is  a  section  of  the  cornea  of  insuf- 
ficient magnitude  to  admit  of  the  easy  escape  of  the 
lens."  Operators  of  to-day  all  agree  with  Dr.  Frick  in 
this  regard. 

On  the  whole,  our  first  American  treatise  on  the  eye 
was  a  fine  example  of  what  a  manual  should  be,  and  for 
many  years  it  was  the  leading  text-book  on  the  subject 
in  this  country  and  was  recommended  by  teachers  and 
surgeons. 

His  work  was  so  well  thought  of  in  England  that  it 
was  republished  there  in  1826  with  notes  by  Richard 
Welbank. 

THE  WORK  OF  JOHX  MASON  GIBSOX. 

"A  Condensation  of  Matter  on  the  Anatomy,  Surgical 
Operations  and  Treatment  of  Diseases  of  the  Eye,  To- 
gether with  Remarks.  Embellished  with  Twelve  Litho- 
graphic Plates,  Illustrative  of  the  Anatomy  and  Morbid 
Appearance.       By  John  Mason  Gibson,  Member  of  the 


OPHTHALMOLOGY  IN  AMERICA.  99 

]\redical  and  Chirurgical  Faculty  of  Maryland.    Balti- 
more:   Published  by  W.  E.  Lucas,  1832/' 

This  was  the  second  American  book  on  the  eye  and  its 
diseases.  It  is  a  small  quarto  volume  of  204  pages,  be- 
sides the  plates  and  the  descriptions  of  them.  As  a  con- 
tribution to  ophthalmologic  literature  it  was  practically 
a  failure.  It  was  badly  written,  illy  arranged,  in  many 
cases  incorrect  as  to  facts,  and  the  illustrations  were 
very  inferior.  It  is  a  book  that  is  scarcely  ever  heard  of, 
and  deserves  oblivion. 

LITTELL^S  MANUAL. 

"A  Manual  of  the  Diseases  of  the  Eye.  By  S.  Lit- 
tell,  Jr.,  M.D.,  one  of  the  surgeons  of  the  Wills  Hospital 
for  the  Blind  and  Lame ;  Fellow  of  the  College  of  Physi- 
cians of  Philadelphia,  etc.  Published  by  John  S.  Littell, 
Philadelphia,  1837." 

In  1846  a  second  American  edition  was  published  by 
Hogan  and  Thompson,  of  Philadelphia,  under  the  title, 
''A  Manual  of  the  Diseases  of  the  Eye :  Or,  Treatise  on 
Ophthalmology." 

This  manual  of  Dr.  Littell  was  not  a  compilation 
merely,  but  it  represented,  especially  in  the  last  edition, 
the  results  of  the  large  experience  of  himself  and  his 
colleagues  in  the  Wills  Hospital.  It  not  only  received 
the  highest  commendation  in  this  country,  but  also  in 
Great  Britain.  The  British  and  Foreign  Medico-Chi- 
rurgical  Review,  at  the  time  of  its  publication,  said : 

It  is  no  small  triumph  to  Dr.  Littell  to  be  able  to  say  that 
he  has  introduced  almost  all  that  is  valuable  and  everything 
absolutely  necessary  to  the  student  within  a  compass  of  250 
pages.  ...  It  is  replete  with  information,  yet  so  terse  in 
style  and  compressed  in  bulk,  as  at  once  to  entice  and  repay 
perusal. 


100  OPHTHALMOLOGY  IX  AMERICA. 

It  was  thought  so  well  of  in  London  that  the  first 
edition  was  revised  and  enlarged  by  Hugh  Houston, 
Member  of  the  Eoyal  College  of  Surgeons,  London,  and 
published  there  by  John  Churchill  in  1838. 

WORK  OF  HEXRY  HOWARD. 

"The  Anatomy.  Physiology  and  Pathology  of  the 
Eye.  By  Henry  Howard,  M.E.C.S..  Surgeon  to  the 
Montreal  Eye  and  Ear  Institution.  London:  John 
Churchill.     Montreal :    Armour  and  Eamsey.     1850." 

This  is  an  octavo  volume  of  xii-518  pages,  and  is 
a  good  compilation,  representing,  without  great  detail, 
the  ophthalmology  of  the  last  part  of  the  first  half  of 
the  nineteenth  century.  Mr.  Howard  had  been  a  stu- 
dent of  the  celebrated  Dr.  Arthur  Jacob,  of  Dublin,  and 
"for  the  last  four  years,  as  surgeon  to  the  Montreal 
Eye  and  Ear  Institution,  has  devoted  his  labors  exclu- 
sively to  the  treatment  of  diseases  incident  to  these  or- 
gans.*' The  work  is  well  arranged,  is  clearly  written, 
and,  although  not  containing  anything  new,  is  a  cred- 
itable production.  It  covers  the  ground  indicated  by  its 
title,  and  due  proportion  is  preserved  throughout  in  its 
various  divisions. 

WILLIAM    CLAY    WALLACE'S    BOOKS. 

Another  small  book  which  attracted  much  attention 
was  by  William  Clay  Wallace.  It  was  first  published  in 
1836.  The  second  edition,  1839,  which  is  in  my  posses- 
sion, was  entitled,  '*A  Treatise  on  the  Eye,  Containing 
the  Discoveries  of  the  Cause  of  Xear  and  Far  Sighted- 
ness,  and  of  the  Affections  of  the  Eetina,  with  Eemarks 
on  the  Use  of  Medicines  as  Substitutes  for  Spectacles." 
This  edition  was  a  12mo  volume  of  about  ninety  pages, 


OPHTHALMOLOGY  IN  AMERICA.  101 

and  dealt  with  the  anatomy  of  the  eye  of  both  man  and 
some  of  the  lower  animals.  The  last  chapter  of  this 
volume  was  reprinted  from  an  article  read  before  the 
New  York  Medical  and  Surgical  Society,  Oct.  21,  1837. 
The  volume  has  very  little  intrinsic  merit.  In  1841  a 
third  edition  was  issued,  somewhat  modified,  and  with 
the  title,  "Wonders  of  the  Vision:  A  Treatise  on  the 
Eye."    Illustrated.    This  edition  I  have  not  seen. 

In  1850  Dr.  Wallace  published  another  book  of  thir- 
ty-six pages  in  duodecimo  form,  entitled  "The  Accom- 
modation of  the  Eye  to  Distances."  New  York:  John 
Wile}^,  publisher.  While  containing  some  of  the  subject 
matter  and  illustrations  of  the  previous  volumes,  this, 
on  the  whole,  was  an  entirely  different  work.  The  au- 
thor says :  "The  substance  of  the  following  essay  has  al- 
ready appeared  in  Silliman's  Journal  for  1835,  the  Lon- 
don Medical  Gazette  for  1842,  and  the  Boston  Medical 
andSurgical  Journal  for  1814."  The  distinctive  features 
of  this  essay  are  the  description  of  the  structure  of  the 
ciliary  body  based  on  the  author's  own  dissections,  and 
contains  his  theory  of  its  functions  and  of  the  "accom- 
modation of  the  eye  to  distances."  The  current  opinion 
of  his  work  in  1839  was  expressed  by  Professor  Knight, 
of  Yale  College,  as  follows : 

"He  has  made  interesting  discoveries  which  throw- 
much  light  on  hitherto  obscure  points  in  the  physiology 
of  vision." 

Professor  Silliman  said :  "I  have  been  very  favorably 
impressed  by  his  various  communications  on  the  eye  and 
topics  relating  to  that  organ." 

Sir  David  Brewster,  at  the  eighth  meeting  of  tlie 
British   Association   for   the   Advancement  of   Science. 


102  OPHTHALMOLOGY  IN  AilERICA. 

laid  before  the  meeting  a  series  of  preparations  of  the 
e3e  made  by  Dr.  Wallace  which,  he  said,  were  calculated 
to  establish  some  important  points  in  the  theory  of  vision. 

JAMES   AV.   POWELL   OX   THE   EYE. 

"The  Eye:  Its  Imperfections  and  Their  Prevention," 
published  by  the  author.  1847. 

This  is  a  small  octavo  volume  of  140  pages,  pub- 
lished, probably,  more  for  the  purpose  of  advertising 
the  author  than  of  enlightening  the  profession.  It  deals 
in  the  most  meager  manner  with  the  "anatomy  and 
physiolog}-  of  the  organ  of  vision,  rules  for  the  preven- 
tion, improvement  and  restoration  of  sight,  with  re- 
marks on  near  sight  and  aged  sight,  on  optics,  and  the 
uses  and  abuses  of  spectacles,  with  directions  for  their 
selection."  The  author  signs  himself  a  member  of  the 
College  of  Surgeons  of  Ireland  and  '•oculist  and  aurist," 
and  says  his  hours  of  attendance  at  his  residence  and 
office,  261  Broadway,  Xew  York,  are  from  9  to  4.  At 
the  conclusion  of  the  book  he  wishes,  also,  to  inform  per- 
sons residing  at  a  distance  that  they  may  obtain  his 
"opinion  on  various  affections  of  the  eye  and  ear  by 
writing  a  description  of  their  case  and  enclosing  a  fee 
of  three  dollars."  Dr.  Powell  was  a  pupil  of  the  cele- 
brated Dr.  Arthur  Jacob,  of  Dublin,  whose  lectures, 
and  those  of  others,  he  attended  from  1828  to  1833. 
Undoubtedly  Dr.  Powell  was  a  well-informed  man,  but 
his  book  shows  that  a  commercial  spirit  dominated  cer- 
tain physicians  half  a  century  ago.  as  well  as  in  our  own 
time. 

WORKS   ox   STRABISMUS. 

As  soon  as  Dr.  Dieffenbach,  of  Berlin,  had  published 
his  operation  for  strabismus,  the  profession  of  the  world 


OPHTHALMOLOGY  IN  AMERICA.  103 

was  very  much  aroused  over  a  procedure  which  appar- 
ently gave  such  marvelous  results.  x\s  has  always  been 
the  case,  American  surgeons  caught  the  enthusiasm  and 
many  were  the  reports  of  operations  made  by  them 
throughout  the  United  States,  and  many  were  the  im- 
provements that  were  suggested.  A  number  of  "treat- 
ises" were  also  soon  published.  It  is  the  latter  that  I 
desire  to  chronicle  in  this  connection. 

As  I  have  already  stated,  Dr.  John  H.  Dix,  of  Boston, 
is  said  to  have  been  the  first  to  perform  Dieffenbach's 
operation  in  the  United  States.  In  1841  he  published  a 
small  book  covering  the  causes,  symptoms  and  operative 
treatment  of  strabismus.  It  is  entitled  "A  Treatise  on 
Strabismus,  or  Squinting,  and  the  New  Mode  of  Treat- 
ment." 

In  the  same  year,  181:1,  Alfred  C.  Post,  of  N'ew  York, 
published  a  small  16mo  volume  on  the  same  subject, 
with  excellent  colored  plates,  illustrating  the  anatomy 
of  the  muscles  involved,  the  instruments  used,  and  the 
methods  of  operation.  It  was  entitled  "Observations  on 
the  Cure  of  Strabismus,  with  an  Appendix  on  a  New 
Operation  for  the  Cure  of  Stammering." 

Following  the  small  works  of  Dix  and  Post  was  that 
of  James  Bolton,  of  New  York,  in  1813,  which  he  enti- 
tled "A  Treatise  on  Strabismus,  With  a  Description 
of  New  Instruments  Designed  to  Improve  the  Oper- 
ation for  Its  Cure,  in  Simplicity,  Ease  and  Safety." 
This  was  a  small  octavo  volume  treating  the  subject  of 
strabismus  very  much  as  the  others  had  done.  Bolton 
was  a  young  man  and  had  undoubtedly  been  attending 
the  clinics  at  the  New  York  Eye  Infirmary,  and, 
through  one  of  his  teachers.  Dr.  John  Kearney  Rodgers, 


104  OPHTHALMOLOGY  IX  AMERICA. 

to  whom  he  dedicated  the  volume,  he  had  become  very 
much  interested  in  the  subject,  had  studied  it  carefulljj 
and  embodied  in  his  "treatise''  the  best  conclusions  of 
the  time. 

Four  years  after  the  works  of  Dix  and  Post,  Dr. 
Frank  H.  Hamilton,  at  that  time  professor  of  surgery 
in  Geneva  Medical  College,  Geneva,  N.  Y.,  published  a 
very  small  16mo  volume,  entitled  "A  Monograph  on 
Strabismus,  with  Cases.''  Buffalo,  X.  Y..  18J:5.  It  was 
scarcely  more  than  a  bound  pamphlet,  which,  he  stated, 
was  for  the  use  of  his  medical  students. 

WEAKNESS   OF.  SIGHT. 

Another  small  book  which  attracted  considerable  at- 
tention was  one  by  John  H.  Dix,  of  Boston,  entitled 
"Treatise  on  the  Xature  and  Treatment  of  Morbid  Sen- 
sibility of  the  Eetina,  or  Weakness  of  Sight.''  Boston, 
1849.  This  little  book  was  the  republication  of  an 
essay  which  gained  the  Boylston  prize  for  1848,  and, 
from  the  standpoint  of  ophthalmologic  knowledge  then, 
it  was  esteemed  an  important  contribution. 

Aside  from  the  binding  into  book  form  of  a  few 
papers  of  minor  importance,  no  other  ophthalmologic 
books  than  those  above  mentioned  were  written  by 
Americans  having  a  professional  standing  during  the 
first  half  of  the  nineteenth  century. 

A.MERICAX  EDITIOXS  OF  EXGLISH   WORKS  OX  DISEASES  OF 
THE   EYE. 

I  will  now  supplement  the  above  notices  of  American 
works  on  the  eye  by  a  list  of  English  works  w^hich  were 
republished  in  this  country  under  the  editorial  super- 
vision of  American  practitioners.     Several  works  were 


OPHTHALMOLOGY  IN  AMERICA.  105 

also  republished  here,  besides  the  ones  that  I  shall  men- 
tion, such  as  the  works  of  Saunders,  Vetch,  and  early 
editions  of  Lawrence  and  Mackenzie,  but  without  Amer- 
ican revision.  The  first  in  the  list  was  Delafield^s  edi- 
tion of  Travers'  work :  "A  Synopsis  of  the  Diseases  of 
the  Eye  and  Their  Treatment,  to  Which  Are  Prefixed  a 
Short  Anatomical  Description  and  a  Sketch  of  the 
Physiology  of  That  Organ,  by  Benjamin  Travers, 
F.E.S.,  surgeon  to  St.  Thomas'  Hospital,  with  notes 
and  additions  by  Edward  Delafield,  M.D.,  surgeon  to 
the  New  York  Eye  Infirmary  and  lecturer  on  diseases 
of  the  e3^e.  First  American  from  the  third  London 
edition.  Published  by  E.  Bliss  and  E.  White,  Xew 
York,  and  H.  C.  Carey  and  I.  Lea,  Philadelphia,  1825," 
8vo,  pp.  xxi-4l:74. 

This  book  was  brought  out  by  Dr.  Delafield  in  this 
country  not  long  after  he  and  Dr.  Eodgers  organized 
the  New  York  Eye  Infirmary.  In  its  English  form, 
the  work  was  a  very  desirable  manual,  but  its  value  was 
materially  enhanced  by  the  numerous  additions  and 
notes,  as  well  as  illustrations,  which  Dr.  Delafield  incor- 
porated. 

"A  Treatise  on  Diseases  of  the  Eye,  by  William 
Lawrence,  F.R.S.  A  new  edition,  with  many  modifica- 
tions and  additions,  and  the  introduction  of  nearly  two 
hundred  illustrations  by  Isaac  Hays,  M.D."  Svo,  pp. 
900.     Philadelphia  :   Lea  &  Blanchard,  1847. 

William  Lawrence's  work  on  the  eye  was  encyclopedic 
in  character,  and  in  its  revised  and  enlarged  form  it  wa? 
cordially  received  by  the  American  profession. 

"Principles  and  Practice  of  Ophthalmic  Medicine  and 
Surgery,  by  T.  Wharton  Jones,  F.R.S.,  etc.,  with  102 


lOG  OPHTHALMOLOGY  IX  AMERICA. 

illustrations.  Edited  by  Isaac  Hays,  M.D.,  surgeon  to 
Wills  Hospital/'  12mo,  pp.  510.  Philadelphia  Lea  & 
Blanehard,  18^9. 

This  work  of  Mr.  Jones  was  issued  by  the  same  pub- 
lishers and  under  the  same  editorial  supervision  as  that 
of  Lawrence.  It  was  more  concise  and  was  intended  to 
serve  the  profession  in  another  way.  In  the  words  of 
the  editor,  ''it  was  one  of  the  series  of  manuals  in- 
tended for  students.  By  its  conciseness  and  systematic 
arrangement  the  author  was  enabled  to  embody  such  ma- 
terial as  would  be  suitable  for  the  student  within  a 
small  compass." 

"Spectacles:  Their  L^ses  and  Abuses  in  Long  and 
Short  Sightedness,  and  the  Pathologic  Conditions  Re- 
sulting from  Their  Irrational  Employment,  by  J. 
Sichel,  M.D.  Translated  from  the  French  by  permis- 
sion of  the  author  by  Henry  W.  Williams,  M.D.  Bos- 
ton:   Phillips,  Sampson  &  Co.,  1850," 

This  was  not  a  republication  of  an  English  author, 
but  was  a  translation  of  an  excellent  French  work  by  the 
learned  Dr.  Sichel,  which  gave  the  latest  views  on  the 
abnormal  refractive  conditions  of  the  eyes,  several  of 
which,  he  believed,  were  caused  by  the  abuse  of  spec- 
tacles. While  these  views  have  radically  changed  since 
that  time  by  the  teachings  of  Bonders,  yet  the  book  ha* 
a  recognized  historical  value. 

PUBLICATIOXS  IX  MEDICAL  PERIODICALS. 

From  the  very  beginning  of  the  last  century  our 
American  medical  periodicals  have  always  been  more  or 
less  alive  to  the  imjxjrtance  of  that  department  of  medi- 
cine pertaining  to  diseases  of  the  eye.  The  American 
Medical  Recorder,  the  Journal  of  the  Medical  and  Phys- 


OPHTHALMOLOGY  IN  AMERICA.  107 

teal  Sciences,  and  the  successor  to  both  of  these,  The 
American  Journal  of  the  Medical  Sciences,  of  Philadel- 
phia, and  the  contemporary  New  England  Journal  of 
Medicine  and  Surgery,  of  Boston,  and  several  medical 
journals  that  were  started  at  about  the  same  time  in  Xew 
York  and  the  West,  all  contain  articles  of  more  or  less 
ophthalmologic  interest. 

Dr.  Frick,  of  Baltimore,  in  1821,  1822  and  1823, 
■contributed,  each  year,  to  the  American  Medical  Re- 
corder (Philadelphia).  His  articles  were  on  the  sub- 
jects of  conjunctivitis,  cataract  and  the  various  modes 
of  operating,  and  on  modes  of  operating  for  artificial 
pupil.  They  were  in  reality  an  extended  summary  of 
what  w^as  known  in  regard  to  those  subjects  at  that 
time,  and  to  the  medical  historian  are  to-day  of  much 
interest.  Since  Frick  published  his  book,  little  or  noth- 
ing is  found  written  by  him. 

The  writings  of  Dr.  Isaac  Hays  were  almost  without 
exception  published  in  the  journals  in  which  he  had  an 
editorial  interest.  As  early  as  1826  and  1827  we  find 
long  and  well  written  articles  on  inflammation  of  the 
conjunctiva  and  of  the  sclera,  in  1828  on  the  diseases  of 
the  cornea  and  their  treatment.  From  that  time  to 
1850  he  published  many  valuable  and  interesting  papers, 
abstracts  and  discussions  on  various  ophthalmologic  sub- 
jects. 

Dr.  Littell  was  not  a  prolific  writer.  The  few  arti- 
cles, however,  that  he  did  write  were  published  in  the 
same  journals  as  those  of  Hays,  and  were  meritorious. 
The  most  frequent  contributors  in  Boston  to  medical 
journals  were  John  Jeffries  (a  few  reports),  John  H. 
Dix  with  great  frequency,  and  later  George  A.  Bethune. 


108  OPHTHALMOLOGY  IN  AMERICA. 

The  ophthalmologic  contributors  in  New  York,  Balti- 
more, Louisville,  Cincinnati  and  other  cities  were  less 
numerous,  but  after  the  announcement,  through  the 
medical  journals,  of  Dieifenbach's  operation  for  strabis- 
mus, the  periodical  literature  on  that  subject  became 
quite  voluminous  and  was  wideh'  scattered  throughout 
America.  In  fact,  there  was  so  much  of  it  that  I  shall 
not  undertake  to  review  it. 

Many  reports  on  rare  cases  of  diseases  of  the  eye, 
many  experiences  and  different  views  on  ophthalmologic 
subjects  were  published  here  and  there  in  the  numerous 
medical  periodicals  of  the  United  States.  These  are 
so  diversified  in  character  and  the  authors  so  many  that 
they,  too,  cannot  be  specifically  referred  to.  One  feature 
of  medical  journalism  in  this  country,  embodied  espe- 
cially in  The  American  Journal  of  the  Medical  Sciences, 
was  reports  of  the  progress  of  the  medical  sciences,  with 
a  department  given  up  exclusively  to  ophthalmology.  I 
believe  it  is  impossible  to  measure  the  good  that  Dr. 
Hays  did  to  the  American  profession  by  publishing, 
from  quarter  to  quarter,  the  essentials  of  the  current 
ophthalmologic  contributions  of  the  world.  The  ab- 
stracts were  of  sufficient  length  to  make  the  subjects 
under  discussion  intelligible,  and,  through  this  channel 
alone,  he  advanced  very  materially  the  knowledge  of 
ophthalmology  in  this  country.  At  the  time  when  this 
was  done  it  was  impossible  for  any  but  an  experienced 
ophthalmologist,  like  Dr.  Isaac  Hays,  to  realize  the 
professional  needs  and  to  be  able  to  supply  them  so  well. 
For  this,  if  nothing  else,  ophthalmology,  to-day.  owes 
this  great  man  an  undying  gratitude. 


OPHTHALMOLOGY  IN  AMERICA.  109 

THESES. 

Besides  the  journalistic  contributions,  I  find  a  num- 
ber of  theses,  or  dissertations  on  the  eye  or  its  diseases, 
of  special  interest,  and  among  them  I  may  mention  one 
on  cataract  by  Isaac  Cleaver,  University  of  Pennsylva- 
nia,  1805    (dedicated   to   Dr.   Phillip   Syng   Physick)  ; 
another  on   the  nature  and  treatment  of   cataract,  by 
Samuel  D.  Gross,  Jefferson  Medical  College^  Philadel- 
phia, 1828   (dedicated  to  George  McClellan),  and  still 
another  on  the  same  subject  by  Arthur  B.  Stout,  College 
of  Physicians  and  Surgeons,  Xew  York,   1837    (dedi- 
cated to  Drs.  Edward  Delafield,  John  Kearney  Rodgers 
and  James  Edward  Cornell)  ;  one  on  the  eye  and  on 
vision  by  Elisha  DeButts,  University  of  Pennsylvania, 
1805    (dedicated  to  Dr.   Casper  Wistar)  ;  one  on  oph- 
thalmia, by  David  Morre,  University  of  Pennsylvania, 
1807    (dedicated    to    Drs.    John    Claiborne    and    John 
B.   Walker,   both  of  Virginia),   and  one  on  Iritis,   by 
Richard  Kissam,  College  of  Physicians  and  Surgeons, 
New  York,  1839   (dedicated  to  Drs.  Edward  Delafield 
and  John  Kearney  Rodgers).     These  essays  have  dis- 
tinct merit  as  representing  the  knowledge  of  the  times 
in  which  they  were  written.     There  undoubtedly  were 
many  other  theses  on  ophthalmologic  subjects,  but  these 
serve  to  indicate  that  ophthalmology  was  by  no  means 
entirely  neglected  in  the  teachings  of  our  early  medical 
schools. 


Y. 

SOME  SPECIAL   AMERICAN   CONTRIBUTIONS   TO 
OPHTHALMOLOGY. 

In  times  past,  as  well  as  to-day,  there  have  been  many 
evidences  of  great  surgical  originality  and  insight  on  the 
part  of  Americans.  In  some  instances  they  have  been 
shown  by  suggestions,  in  others  by  demonstrating  im- 
portant procedures  and  devices.  When  Dieffenbach's 
operation,  for  example,  had  been  made  public,  it  wa? 
found  that  the  same  operation  had  long  before  been 
suggested  and  even  performed  in  this  country.  The 
great  misfortune  was  that  the  genius  of  our  American 
surgeons  had  not  always  been  put  more  fully  into  light 
and  recorded. 

DR.   IXGALLS^   SUGGESTION   OF  THE  OPERATION  FOR 
STRABISMUS 

was  made  as  early  as  1812,  as  is  proved  by  the  follow- 
ing: 

PROvn)EXCE.   Feb.   8,    1841. 

To  the  Editors  of  the  Medical  Examiner. 

Gentlemen: — I  have  this  day  received  the  following  letter 
from  Samuel  Y.  Atwell,  Esq.,  of  this  city,  in  which  he  gives 
the  credit  of  having  first  suggested  the  operation  for  strabis- 
mus to  Dr.  William  Ingalls  of  Boston. 

Mr.  Atwell  is  an  eminent  member  of  the  legal  profession  in 
this  state,  and  his  statements  are  worthy  of  the  highest  credit. 

I  think  it  due  to  Dr.  Ingalls  that  the  fact  of  his  having  first 
suggested  the  operation,  should  be  made  known  to  the  profes- 
sion. 


OPHTHALMOLOGY  IN  AMERICA.  Ill 

I  also  send  you  notes  of  two  eases  of  strabismus  on  which  J 
have  operated  successfully.    Your  obedient  servant, 

Henry  Wheaton  Rivers,  M.D. 


Providence,  Feb.  8,  1841. 

Dear  Sir: — I  observe  from  the  newspapers  that  you  have 
operated  with  great  success  in  several  cases  of  strabismus,  or 
squinting.  I  have  also  noticed  this  operation  spoken  of  as  a 
new  discovery  in  the  art  of  surgery,  and  is  said  to  have  lately 
originated  in  Germany.  Now,  sir,  I  think  we  should  give  honor 
where  honor  is  due.  In  the  years  1812  and  '13  I  attended 
courses  of  surgical  and  anatomic  lectures  delivered  before  the 
Medical  School  of  Brown  University,  by  William  Ingalls,  M.D., 
of  Boston,  then  the  professor  of  anatomy  and  surgery  in  that 
institution;  being  subject  myself  to  this  infirmity  (strabismus), 
Dr.  Ingalls  took  frequent  opportunities  to  explain  to  me  the 
method  of  its  surgical  cure;  he  did  this  by  discecting  the  eye 
itself,  explaining  the  power  and  disposition  of  several  muscles 
appertaining  to  that  organ,  and  showed  me  how  by  division 
of  one  or  more  of  them,  the  eye  might  be  brought  to  its  proper 
place.  In  my  own  case  I  know  he  proposed  to  divide  the 
rectus  internus.  So  strongly  was  I  impressed  with  the  prac- 
ticability and  success  of  this  ojjeration,  that  I  strongly  urged 
my  father  to  permit  me  to  submit  to  the  operation;  but  upon 
the  nature  of  the  operation  being  explained  to  him,  he  de- 
clined the  permission,  because  he  feared  the  effect  might  be  to 
turn  the  eye  the  other  way. 

I  make  this  statement  in  justice  to  my  friend  and  quondam 
master,  and  to  show  that  we  have  surgeons  in  this  country  as 
learned  in  their  profession  as  some  in  Europe.  Respectfully, 
your  obedient  servant.  Samuel  Y.  Atwell. 

To  Henry  W.  Rivers,  M.D.,  Providence,  R.  I. 

Then  follows  a  report  of  two  cases  successfully  oper- 
ated on  by  Dr.  Rivers  on  Dec.  23,  1840,  and  Jan.  13, 
1841,  respectively,  by  dividing  the  rectus  muscle   (ex- 


112  OPHTHALMOLOGY  I\  AMERICA. 

ternus,  first  case,  divergent;  internus.  second  case,  cou- 
vergent).-" 

Soon  after  that  William  Gibson,  who  was  then  pro- 
fessor of  surgery  at  the  University  of  Maryland,  actual- 
ly operated  for  this  condition.  Dr.  M.  D.  Reese,  in 
18-1:2.  in  his  supplement  to  the  "Surgical  Dictionary'^  of 
Samuel  Cooper  (p.  127),  refers  to  the  subject  in  these 
words : 

It  appears  from  the  "Institutes  of  Surgery"  that  Professor 
Gibson  attempted  the  cure  of  strabismus  by  dividing  the  recti 
muscles  of  the  eye  precisely  as  now  practiced,  some  twenty 
years  since  in  Baltimore.  Soon  after,  he  repeated  it  unsuc- 
cessfully, in  Philadelphia,  in  several  cases,  and  was  induced  to 
abandon  it  by  the  unfavorable  opinions  expressed  on  the 
operation  by  Dr.  Physiek.  He,  however,  inculcated  the  propri- 
ety of  the  operation  on  his  class  many  years  since,  and  Dr.  A. 
E.  Hosack  of  New  York,  then  one  of  his  pupils,  distinctly 
recollects  Dr.  Gibson's  expressions  of  confidence  that  the  opera- 
tion would  ultimately  succeed. 

Dr.  Gibson  himself  in  the  sixth  edition  of  his  "Insti- 
tutes of  Surgery,^'  published  in  1841,  describes  in  detail 
the  operations  which  he  performed  in  1818,  and  also 
adds  that  on  the  advice  of  Dr.  Physiek  he  was  led  to 
abandon  these  experiments.  His  reference  to  the  sub- 
ject will  be  found  on  page  375  of  his  work. 

Dr.  Harry  Friedenwald,  of  Baltimore,  in  his  "Early 
History,"  etc.,  quotes  Dr.  Gibson's  remarks  in  full. 

Gibson's  scissors  for  operation  of  absorption  of 
cataract. 

William  Gibson,-"*  then  professor  of  surgery.  Univer- 
sity of  Pennsylvania,  in  1821,  described  an  instrument 

23.  Philadelphia  Medical  Examiner,  iv,  119. 

24.  Phila.   Jour.   Med.   and   Phys.  Sci.,  1821,  iii,  192. 


OPHTHALMOLOGY  IN  AMERICA.  113 

for  "cutting  to  pieces  the  crystalline  lens  in  all  cases  of 
cataract."    It  was  a  pair  of  scissors,  thus  described : 

So  delicate  as  hardly  to  exceed,  in  size,  the  iris  knife  of  Sir 
William  Adams,  and  at  the  same  time,  so  strong  and  sharp  as 
to  cut,  with  ease,  the  most  solid  and  compact  lens  and  cap- 
sule, without  injuring,  in  the  slightest  degree,  any  part  of  the 
eye.  These  scissors  are  formed  on  the  principle  of  Mr.  Willas- 
ton's  scissors,  used  for  common  purposes — with  the  edge  so 
constructed  as  to  operate  like  a  knife.  On  this  account,  the 
instrument  perforates  the  coats  of  the  eye  with  the  utmost 
facility,  and  when  introduced,  the  blades  can  be  opened  to  a 
certain  extent  so  as  to  cut  the  lens  to  pieces  without  bruis- 
ing it  or  any  other  part — the  necessary  effect  of  scissors,  as 
they  are  usually  made.  This  instrument  possesses  another 
advantage — the  lens  is  supported  in  its  natural  situation  dur- 
ing the  operation,  by  having  one  blade  behind,  and  the  otheij 
before  it,  so  that  it  may  be  cut  to  pieces,  in  situ,  and  its 
remains  afterwards  forced,  by  the  shut  blades,  into  the  an- 
terior chamber,  for  dissolution. 

At  the  time  Dr.  Gibson  suggested  this  instrument, 
"dissolution"  of  cataract  had  become  a  popular  method 
of  operating  through  the  influence  of  Saunders  and 
Adams,  of  London,  and  the  scissors  were  offered  as  a 
substitute  for  needles,  the  use  of  which  was  frequently 
attended  by  dislocation  of  the  lens  into  the  vitreous 
humor. 

ANOTHER  INGENIOUS   METHOD   OF   ABSORBING    CATARACT. 

Dr.  Gibson's  originality  was  further  illustrated  by 
another  method  which  he  adopted  for  the  absorption  of 
cataract.^^  His  operation  was  described  by  Dr.  J. 
Revere,  of  Baltimore,  in  a  letter  dated  March  2,  1819. 
It  consisted  in  passing  "a  common  sewing  needle,  slight- 
ly  curved   and   armed   with   a   single   thread   of   silk" 

25.  New  England  Journal  of  Medicine  and  Surgery,  1818,  viii, 
119. 


114  OPHTHALMOLOGY  IX  AMERICA. 

through  the  sclera  about  two  lines  from  the  cornea, 
through  the  opaque  lens  and  sclera  of  the  opposite  side 
at  a  point  corresponding  to  the  one  at  which  it  was 
introduced,  the  pupil  having  been  previously  dilated 
with  belladonna.  "The  silk  being  drawn  through  and 
the  ends  cut  off.  a  single  thread  was  thus  left  passing 
through  the  ball  of  the  eye  and  acting  on  the  diseased 
lens  in  the  manner  of  a  seton."  Dr.  Gibson  had  oper- 
ated in  this  manner  on  two  cases.  "Xo  reaction  or  acci- 
dent intervened,  and  at  the  end  of  ten  days,  in  both 
cases,  the  diseased  lens  had  disappeared.'^  The  silk 
was  then  withdrawn  and  in  a  few  days  the  vision  was 
restored.  In  a  third  case  in  which  this  operation  was 
performed  "it  failed  in  consequence  of  the  iris  being 
wounded"  and  the  thread  was  withdrawn  at  an  early 
period  because  of  inflammation.  The  wound  of  the 
iris  was  attributed  to  not  using  belladonna. 

horxer's   operatiox   for   ectropiox   of   the   lower 

LID. 

Dr.  Horner,  like  many  others,  devised  a  very  ingen- 
ious operation  for  ectropion  of  the  lower  lid  which  he  de- 
scribed in  the  American  Journal  of  the  Medical  Sciences, 
1837,  vol.  xxi,  p.  105.  It  deserves  to  be  remembered 
as  an  original  and  effective  method  of  correcting  this 
deformity.  Dr.  Horner  had  performed  it  as  follows: 
"An  incision,  two  inches  in  length  and  down  to  the 
bone,  was  made  parallel  with  and  at  the  inferior  margin 
of  the  orbicularis  muscle.  The  whole  thickness  of  the 
eyelid  was  then  dissected  up  from  the  adjoining  bones. 
From  about  the  middle  of  that  incision  started  another, 
of  an  inch  in  length,  downward  toward  the  angle  of 
the  jaw.     From  the  termination  of  the  latter  another 


OPHTHALMOLOGY  IN  AMERICA 


115 


■  incision  of  the  same  length  was  directed  toward  the  root 
of  the  nose.  The  two  last  incisions  consequently  de- 
fined an  angle  of  integuments,  which,  being  dissected 
up  as  far  as  its  base,  was  then  turned  into  the  begin- 
ning of  the  first  incision.  The  following  diagram  will 
illustrate  the  operation. 


^^*X;^_^_^ 

^^^^"^ 

~> 

Diagrams  illustrating  Horner's  operation. 

"The  angle  A,  Figure  1,  taken  from  the  cheek  was 
inserted  into  the  lower  eyelid,  as  seen  in  Figure  2,  and 
a  pin  fixed  at  b  and  another  at  c,  so  as  to  keep  the  parts 
in  place.  An  almost  immediate  correction  of  the  de- 
formity ensued. ^^ 

The  ordinary  dressings  were  applied  over  the  eye  and 
recovery  was  rapid. 

OPERATION   FOR  BLEPHAROSPASM. 

Dr.  George  C.  Blackman,  a  prominent  surgeon  of 
New  York,  again  illustrated  the  resourcefulness  of  our 
American  surgeons  by  devising  a  method  of  operating 
for  blepharospasm,  which,  in  a  modified  form,  has  since 


IK)  OPHTHALMOLOGY  IX  AMERICA. 

been  widely  practiced.  His  case  was  recorded  in  the 
New  York  Lancet,  1842,  vol.  i,  p.  410.  The  operation 
was  used  as  a  last  resort  after  every  remedy  which 
seemed  applicable  had  been  unsuccessfully  tried.  Dr. 
Blackman's  description  is  as  follows : 

After  explaining  to  the  patient  the  nature  of  the  operation 
which  I  thought  likely  to  raise  (open)  the  eyelid,  she  readily 
consented  to  its  performance.  With  the  assistance  of  Prof. 
Willard  Parker  and  Dr.  Hall,  I  divided  the  musculi  orbicu- 
laris palpebrarum  in  the  follcwing  manner:  The  patient  wa^ 
seated  on  a  low  stool  before  the  window;  Professor  P.  then 
passed  a  smooth  ivory  handle  beneath  the  lid,  in  order  to  pro- 
tect the  eyeball,  whilst  with  a  straight,  narrow  tenotome,  a 
puncture  was  made  near  the  outer  margin  of  the  lid,  and  mid- 
way between  the  outer  and  the  inner  angle.  The  knife  was 
passed  on  towards  the  superciliary  ridge,  when,  turning  the 
edge  towards  the  muscle,  and  by  gently  pressing  during  the 
act  of  withdrawing,  its  fibers  were  easily  divided.  The  muscle 
both  at  the  inner  and  outer  edge  of  the  eye  I  divided  in  the 
same  manner,  in  every  instance  leaving  the  conjunctiva  entire. 
Instantly  our  patient  remarked  that  she  could  raise  the  lid  so 
as  clearly  to  distinguish  objects  across  the  street.  Professor 
P.  then  suggested  that  the  division  of  the  lower  portion  of  the 
muscle  might  relieve  the  entropion  of  the  lower  lid.  This  I 
divided  in  the  manner  before  mentioned,  and  much  to  our 
satisfaction,  the  entropion  immediately  disappeared.     .     .     . 

From  the  happy  effects  which  followed  the  division  of  the 
muscle  in  the  lower  lid,  as  Professor  Parker  recommended,  I 
have  but  little  doubt  but  that  we  now  possess  an  easy  and 
effectual  remedy,  perhaps  in  a  majority  of  the  cases  of  this 
troublesome  affection.  G.  C.  Blackman,  M.D. 

Xew  York,  June  14,  1842. 

BLEPHARO  PLASTY. 

Alfred  C.  Post  was  probably  the  first  in  America  to 
successfully  perform  plastic  operations  to  correct  de- 
formities of  the  lids  resulting  from  cicatrices.    His  first 


OPHTHALMOLOGY  IN  AMERICA.  117 

account  was  published  in  the  New  York  Medical  Ga- 
zette^ Jan.  19,  1842.  His  example  was  soon  imitated 
by  Dr.  J.  Mason  Warren  of  Boston,  Dr.  George  McClel- 
lan  and  Dr.  Mutter  of  Philadelphia  and  others.  Dr. 
Horner's  method,  which  was  reported  in  the  American 
Journal  of  the  Medical  Sciences  for  1837,  was  entirely 
different  in  its  principles. 

INSTRUMENTS   AND   OPERATION   FOR  LACHRYMAL 
STRICTURE. 

Dr.  Xathan  E.  Smith,  the  eminent  Baltimore  surgeon, 
early  devised  a  knife  for  dividing  strictures  of  the  nasal 
duct.  His  instrument  is  figured  in  vol.  iii,  p.  161,  of 
Norris  and  Oliver's  System  of  Diseases  of  the  Eye.  The 
operation  which  he  performed  antedated  Still ing's  by 
many  years,  having  been  done  as  early  as  184G  at  least. 
Dr.  Smith  also  used  gold  lachrymal  canulge  of  his  own 
device,  which  were  an  improvement  on  the  old  forms.-^ 

ABSCISSION   OF   THE   CORNEA. 

Prof.  L.  A.  Dugas,  of  Augusta,  Ga.,  was  an  eminent 
surgeon  of  the  South  who  also  gave  much  attention  to 
diseases  of  the  eye.  In  1840  he  practiced  an  operation 
on  the  eye  in  certain  conditions  of  corneal  staphyloma, 
which  has  since  met  with  much  favor  by  experienced 
ophthalmologists.  The  operation  was  the  abscission  of 
the  cornea,  which  he  did  "by  passing  a  tenaculum 
through  the  cornea  and  excising  it  with  the  straight 
bistoury  without  touching  the  sclerotica."  Dr.  Dugas 
seems  to  have  used  proper  discrimination  in  his  cases 
and  preferred  this  method  to  the  excision  of  the  whole 

26.  Norris  and  Oliver's  System,  iii.  ir>7. 


118  OPHTHALMOLOGY  IS  AMERICA. 

eyeball.  The  deformity  resulting  from  his  operation 
was  greatly  diminished,  while  the  removal  of  the  cornea 
was  attended  with  no  danger.-" 

CHLORID  OF  SODIUM  IN  PURULENT  OPHTHALMIA. 

Dr.  L.  A.  Dugas,  of  Augusta,  Ga.,  published  a  paper 
in  the  Southern  Medical  and  Surgical  Journal  for  1837 
on  "Purulent  Ophthalmia/'  in  which  he  related  several 
cases,  all  of  which  were  successfully  treated  by  a  solu- 
tion of  chlorid  of  sodium  as  a  wash,  one-half  ounce  to  a 
quart  of  water. 

If  there  were  no  medicinal  properties  in  chlorid  of 
sodium,  it  served  the  purpose  of  cleanliness  at  least, 
and  it  is  possible  that  effectual  cleanliness  in  purulent 
conjunctivitis  is  better  than  the  indiscriminate  use  of 
some  of  the  strong  drugs  which  have,  during  later  years, 
been  so  popular. 

POTASSIUM  lODID  IN  DISEASES  OF  THE  EYE. 

As  early  as  1842  Dr.  Isaac  Parrish,-^  of  Philadelphia, 
recommended  this  drug  in  certain  ophthalmic  diseases, 
in  doses  of  from  two  to  six  grains,  three  times  a  day. 
He  believed  it  had  potency  in  relieving  inflammatory 
affections  "involving  the  deep  tunics  of  the  eye." 

HORNER^S   MUSCLE. 

In  1824  Dr.  William  E.  Horner  (1790-1853),  of 
Philadelphia,  who  was  an  excellent  anatomist  and  very 
painstaking  and  minute  in  his  dissections,  described^^ 
a  muscle  which  he  believed  to  be  separate  from  the  or- 

27.  Reese :  Cooper's  Surgical  Dictionary,  Supplement,  1842, 
p.  75. 

28.  Medical  Examiner,  April  16,  1842. 

21).  Phila.  Jour,  of  Med.  and  Phys.  Sci.,  1824,  viii,  70. 


DR.  WILLIAM  E.  HORNER   (1790-1853). 


OPHTHALMOLOGY  IN  AMERICA.  121 

bicularis  of  the  eyelids  and  which  extended  along  the 
course  of  the  lachrymal  canals  of  the  lids  from  the  crest 
of  the  lachrymal  bone  to  the  lachrymal  puncta.  The 
article  was  entitled  "Description  of  a  Small  Muscle  of 
the  Inner  Commissure  of  the  Eyelids."  He  said  that  a 
^^compend  of  the  foregoing  description  was  published 
two  years  ago"  (p.  72).  The  function  of  this  muscle 
he  believed  to  be  to  "apply  the  puncta  lachrymalia  to 
the  ball  of  the  eye."  This  muscle  has  from  that  time 
been  called  "Horner's  muscle"  in  almost  all  of  the  ana- 
tomic descriptions  of  the  eye,  and  has  been  regarded  by 
physiologists  as  having  the  special  function,  noted  by 
Dr.  Horner  himself,  of  facilitating  the  excretion  of  the 
tears.  While  it  is  a  structure  of  small  size,  yet  it  de- 
serves the  attention  that  it  has  received,  and  has  a  use- 
ful function  in  the  "economy"  of  the  eye.  Horner  will 
be  remembered  for  many  generations  as  its  discoverer. 

FIPST     CASE     OF     ASTIGMATISM     IN     THIS     COUNTRY     FOR 
WHICH    CYLINDRICAL    GLASSES    WERE    MADE. 

Isaac  Hays,  in  his  American  edition  of  Lawrence  on 
"Diseases  of  the  Eye,"  of  1854,  p.  669,  and  Dr.  Henry 
D.  Noyes,  of  New  York,  in  the  American  Journal  of  the 
Medical  Sciences,  1872,  vol.  Ixvii,  p.  355,  both  described 
the  case  of  Rev.  Mr.  Goodrich,  who  had  deficiency  of 
sight,  which  he  called  "near  sighted,"  because  he  was 
obliged  to  approach  nearer  to  objects  to  see  them  than 
most  persons.  This  man  had  noticed  that  in  looking  at 
lines,  or  branches  of  trees,  or  the  rigging  of  a  ship,  that 
those  objects  having  a  vertical  direction  were  more  dis- 
tinct than  those  having  a  horizontal  direction.  In  1828 
he  consulted  a  skilled  optician,  Mr.  John  McAllister,  of 


122  OPHTHALMOLOGY  IX  AMERICA. 

Philadelphia.  After  studying  the  case  and  making 
tests,  McAllister  had  a  glass  ground,  ^'plane  on  one  side 
and  to  a  section  of  a  cylinder  on  the  other."  This  cor- 
rected the  irregular  refraction  and  the  vision  was  much 
improved.  Mr.  Goodrich  later  became  chaplain  of  the 
Xew  York  State  Lunatic  Asylum  at  Utica,  and  Dr. 
Xoyes  came  into  possession  of  the  glasses.  Dr.  Xoyes 
says:  ^'They  were  given  to  me  in  a  piece  of  writing 
paper  on  which,  in  the  owner's  handwriting,  was  in- 
scribed the  following  memorandum :  ^Xumber  7, 
French  number,  cylinder  cone,  got  of  McAllister,  May, 
1828.''' 

Dr.  Xoyes  stated  that  they  were  plano-concave  cylin- 
ders of  seven  inches'  focus,  with  axes  horizontal,  and 
were  mounted  in  a  spectacle  frame  with  oval  rims.  It 
is  believed  that  these  were  the  first  of  the  kind  made 
in  this  countr}',  and,  according  to  Dr.  Xoyes,  "they  have 
become  historical." 

DISLOCATIOX    OF    THE   LEXS. 

It  is  said  that  Dr.  J.  C.  Warren  was  the  first  to  de- 
scribe a  case  of  accidental  dislocation  of  the  crystalline 
lens.^'^  He  also  called  the  attention  of  the  profession  to 
"rheumatic  inflammation  of  the  eye,  now  universally 
recognized,  but  then  little  was  known  of  its  diagnosis."^^ 

'^inverted''  visiox. 
It  is  very  interesting  in  this  connection  to  note  that 
perhaps  the  first  case  on  record  of  so-called  "inverted" 
vision  was  reported  by  Dr.  John  D.  Godman,  of  Phila- 
delphia, in  1827."^    His  article  is  headed,  "Xote  of  an 

30.  Xew  England  Med.  Jour..  1811. 

31.  Reese's  Supplement  to  Cooper's  Surgical  Dictionary,  p.  75. 

32.  American  Journal  of  the  Medical  Sciences,  1827,  i,  183. 


OPHTHALMOLOGY  IN  AMERICA.  123 

Interesting    Fact    Connected    with    the    Physiology    of 
Vision,"  which  he  reports  as  follows: 

The  following  instance  communicated  to  me  by  Reuben 
Peale,  Esq.,  the  uncle  of  the  young  man,  is  the  only  one  with 
which  we  are  at  present  acquainted,  where  the  inversion  of 
objects  on  the  retina  was  productive  of  inaccuracy  of  judg- 
ment as  to  position,  notwithstanding  all  the  other  senses  were 
in  their  ordinary  condition,  and  the  individual  had  arrived  at 
the  age  of  7   years. 

When  his  father,  who  was  a  distinguished  artist,  began  to 
give  him  lessons  in  drawing,  he  was  very  much  surprised  to 
find  that  whatever  object  he  attempted  to  delineate,  he  uni- 
formly inverted.  If  ordered  to  make  a  drawing  of  a  candle  and 
candlestick  set  before  him,  he  invariably  drew  it  with  the 
base  represented  in  the  air  and  the  flame  downwards.  If  it 
was  a  chair  or  table  he  was  set  to  copy,  the  same  result  was 
the  consequence;  the  feet  were  represented  in  the  air,  and 
the  upper  part  of  the  object,  whatever  it  might  be,  was  turned 
to  the  ground.  His  father,  perplexed  at  what  he  considered 
the  perverseness  of  the  boy,  threatened,  and  even  did  punish 
him  for  his  supposed  folly.  When  questioned  on  the  subject 
the  youth  stated  that  he  drew  the  objects  exactly  as  he  saw 
them,  and  as  his  drawings  were  in  other  respects  quite  accu- 
rate, there  was  no  reason  to  doubt  his  statement.  Whenever 
an  object  was  inverted  previous  to  his  drawing  it,  the  draw- 
ing was  made  to  represent  it  in  its  proper  position,  showing 
that  the  sensations  he  received  from  the  eye  were  exactly 
correspondent  with  the  inverted  pictures  formed  on  the  retina. 
This  condition  of  his  vision  was  observed  to  continue  for  more 
than  a  year,  when  his  case  gradually  ceased  to  attract  atten- 
tion, which  was  when  he  was  about  8  years  old.  Since  that 
time  he  has  imperceptibly  acquired  the  haoit  of  seeing  things 
in  their  actual  position. 

COLOR   BLINDNESS. 

This  visual  defect  received  attention  in  this  country 
long  before  the  publication  of  George  Wilson's  book  in 


124  OPHTHALMOLOGY  IX  AMERICA. 

Edinburgh  in  1855.  As  early  as  1840^''  Dr.  Isaac  Hays 
reports  the  case  of  a  young  woman  who  was  unable  to 
distinguish  certain  colors.  Supplementing  this  report, 
he  discusses  the  subject  quite  fully,  and  gives  references 
to  the  literature  from  the  time  of  Dalton,  in  1794,  to 
the  time  of  the  writing  of  this  article.  He  believed  the 
imperfection  to  be  a  very  curious  one,  and  finds  that  it 
occurs  in  persons  whose  vision  is  natural  and  who  can 
see  minute  objects,  often  with  perfect  distinctness.  He 
also  found  it  to  be  hereditary,  "or,  at  least,  to  prevail  in 
certain  families."  The  various  theories  which  had  been 
previously  put  forward,  he  thought,  did  not  explain  the 
phenomenon.  He  believed  the  condition  to  be  incurable. 
The  subject  was  again  taken  up  by  Dr.  Pliny  Earle, 
of  Philadelphia,  in  1845.^'*  Dr.  Earle's  article  is  a 
most  learned  one  and  treats  of : 

1.  Cases  heretofore  unpubhshed. 

2.  Peculiarities  heretofore  observed:  (a)  the  inability  to 
distinguish  colors  is  hereditary;  (b)  when  thus  entailed  it 
sometimes  overleaps  one  generation  or  more;  (c)  males  are 
more  frequently  affected  than  females. 

3.  Peculiarities  heretofore  unnoticed:  (a)  the  power  of 
accurately  distinguishing  colors  varies  at  different  times  in  the 
same  individual;  (b)  the  inability  to  distinguish  colors  is  not 
infrequently  connected  with,  or  accompanied  by  a  defective 
power  of  discriminating  between  musical  notes. 

He  concludes  by  referring  to  "the  several  theories 
promulgated  by  different  authors  as  explanatory  of  the 
inability  to  distinguish  colors,"  and  said  that  "they  may 
be  resolved  into  two  classes :  first,  those  which  place  the 
cause  of  the  defect  in  the  apparatus  of  vision,  and, 
second,  those  which  suppose  it  to  be  in  the  organ  of 

33.  Am.  Jour.  Med.  Sci.,  1840,  xxvi,  277. 
.•^4.  Am.  Jour.  Med.  Sci..  N.  S..  ix,  .346. 


OPHTHALMOLOGY  IN  AMERICA.  125 

perception/'  adding  that  "we  are  disposed  to  give  pref- 
erence to  the  latter,  but  we  have  nothing  on  the  subject 
to  add  to  the  excellent  treatise  of  Dr.  Hays."  Probably 
up  to  the  time  of  these  papers  nothing  more  enlightening 
had  been  written  on  the  subject. 

''XEOMACROPIA.'' 

In  1849^^  the  late  Prof.  Chester  Dewey,  of  Rochester, 
X.  Y.,  published  a  brief  but  interesting  paper  entitled, 
"On  an  Unnoticed  Kind  of  Abnormal  Vision."  Ex- 
pressing himself  according  to  the  knowledge  of  that 
time,  he  said  that  there  were  two  well-known  kinds  of 
abnormal  vision  in  eyes  not  diseased,  "the  far  sighted 
and  the  near  sighted."     He  then  adds : 

There  is  a  kind  of  abnormal  vision,  different  from  either  of 
these,  which  is  not  farsighted  or  nearsighted,  but  in  which  small 
near  objects,  or  larger  distant  objects,  are  not  seen  with  distinct- 
ness. This  imperfection  occurs  in  children  and  young  persons  and 
is  remedied  by  convex  spectacles  which  are  suited  to  the  eyes 
of  persons  from  65  to  70  years  of  age.  The  younger  eyes  re- 
quire the  older  glasses  and  with  advancing  years  less  convex 
glasses  are  required.  At  the  age  of  45,  or  more,  this  kind  of 
abnormal  vision  becomes  much  diminished.  As  the  young  use 
glasses  of  the  farsighted,  this  kind  may  be  called  neo-macropia. 
It  is  evident  that  convex  glasses  produce  that  change  in  the 
rays  of  light  ^^hich  fits  such  eyes  to  see  distinctly  small  and 
large  objects  at  varying  distances.  This  fact  proves  that 
there  is  no  defect  in  the  adjusting  power  of  the  eyes.  The 
cause,  then,  is  to  be  sought  in  the  structure  of  the  eye. 

Professor  Dewey  said  this  "abnormal  vision"  had  not 
attracted  attention,  for  he  had  found  but  one  allusion 
to  it  in  authors  on  optics,  although  it  was  relatively 
common.  In  Xew  England  and  New  York  more  than 
fifty  instances  had  come  to  his  knowledge.     A  child  of 

3.J.  American  Journal  of  Science  and  Arts,  1849,  viii,  443. 


126  OPHTHALMOLOGY  IX  AMERICA. 

15  was  enabled  for  the  first  time  to  see  distinct!}-  by 
using  his  grandfather's  glasses.  A  young  man  of  18 
required  glasses  of  ten-inch  focus.  Poor  progress  of 
children  in  study  occurred  because  they  were  not  able 
to  see  distinctly,  and  this  defect  had  not  been  sus- 
pected. "Knowledge  of  this  subject  will  make  spec- 
tacles a  still  greater  benefit  to  our  race.'' 

ACCOMMODATION  OF  THE  EYE  ACCORDING  TO  DR.  HOSACK, 

1794. 

The  mechanism  of  the  adjustment  of  vision  to  dif- 
ferent distances  has  always  been  an  interesting  problem, 
and  it  was  one  to  receive  scholarly  attention  in  this 
country  in  1813  by  Dr.  David  Hosack  (1769-1835), 
who  was  one  of  our  most  celebrated  physicians.  Pre- 
vious to  his  time,  Descartes  had  expressed  the  opinion 
that  accommodation  of  the  eye  was  effected  by  the  ac- 
tion of  the  ciliary  processes  on  the  crystalline  lens  in 
such  a  way  as  to  make  it  more  or  less  convex;  Kepler. 
Ziun  and  Porterfield.  that  it  was  done  by  the  lens  being 
moved  nearer  to  the  cornea;  La  Chariere.  Brisseau, 
Perault.  by  being  moved  nearer  to  the  retina;  while 
others  held  that  the  change  was  made  by  variations  in 
the  size  of  the  pupil. 

Thomas  Young  had  endeavored  to  prove  that  the  ad- 
justment was  produced  by  a  change  of  the  curvature  of 
the  crystalline  lens  through  muscle-tissue  existing  in  it. 
Mr.  Young's  paper  was  published  in  the  Philosophical 
Transactions  of  London  in  1T93.  In  1T94  Dr.  Hosack 
followed  up  the  discussion  by  a  paper  in  the  same  trans- 
actions for  that  year,  in  which  he  took  issue  with  all 
opinions  previously  expressed.     In  April,  1813,  he  ro- 


OPHTHALMOLOGY  IN  AMERICA.  127 

published  his  paper  in  the  American  Medical  and 
Philosophical  Register,  Xew  York,  under  the  title,  "Ob- 
servations on  Vision."  It  is  an  extended  experimental 
study  in  which  he  endeavors  to  prove  that  the  change 
of  focus  of  the  eye  is  effected  by  the  action  of  the  exter- 
nal recti  muscles,  and  to  disprove  all  the  theories  tliat 
had  been  presented  up  to  that  time.  His  paper  con- 
cludes with  the  following  summary : 

I  have  thus  endeavored,  first,  to  point  out  the  limited  action 
of  the  iris,  and  of  consequence,  the  insufficiency  of  this  action 
for  explaining  vision.  Secondly,  to  prove  that  the  lens  pos- 
sesses no  power  of  changing  its  form  to  the  different  distances 
of  objects.  Thirdly,  that  to  see  objects  at  different  distances, 
corresponding  changes  of  distance  should  be  produced  between 
the  retina  and  the  anterior  part  of  the  eye,  as  also  in  the  re- 
fracting powers  of  the  media  through  which  the  rays  of  light 
are  to  pass.  And  fourthly,  that  the  combined  action  of  the 
external  muscles  is  not  only  capable  of  producing  these  effects, 
but  that  from  their  situation  and  structure  they  are  also  pecu- 
liarly adapted  to  produce  them. 

THE   THEORY   OF   ACCO:\IMODATIOX   ACCORDING   TO   DR.    H. 
MORTON,    1831. 

A  discussion  on  this  subject  was  again  renewed  in 
this  country  by  Dr.  H.  Morton,  of  New  York  City,  in 
1831,  in  a  paper,  "On  the  Adaptive  Powers  of  the 
Eye."^*^  This  was  a  laborious  effort  to  invalidate  all  the 
experiments  and  conclusions  before  advanced,  and  every 
available  argument  was  used  to  show  that  the  focal 
adjustment  of  the  eye  was  produced  by  the  action  of  the 
iris  in  dilating  and  contracting  the  pupil : 

The  iris,  by  its  contraction  and  dilatation,  admits  the  requis- 
ite number  of  visual  rays  to  pass  through  that  portion  of  the 

:iO.  Am.   .lour.   Med.   Sci.,   1831.   ix,  51. 


128  OPHTHALMOLOGY  IX  AMERICA. 

crystalline  lens  which  will  cause  them  to  reach  the  retina  at 
their  proper  foci,  while  at  the  same  time  it  excludes  in  the 
most  effectual  manner  all  unnecessary  light,  and  all  collateral 
or  direct  rays. 

THE   MECHAXISM    OF   ACCOMMODATION   OF   DR.    WALLACE. 

The  next  conspicuous  study  of  the  accommodation  of 
the  eye  was  made  by  William  C.  Wallace,  of  Xew  York, 
already  referred  to.  By  his  numerous  dissections  of  the 
eye  and  his  minute  study  of  the  ciliary  body,  both  in 
man  and  animals,  beginning  in  1835,  he  came  to  the 
conclusion  that  the  adjustment  of  vision  to  different 
distances  was  accomplished  by  the  action  of  the  ciliary 
muscle  and  by  the  "erection^'  of  the  ciliary  processes  in 
such  a  way  as  to  change  the  position  of  the  crystalline 
lens  farther  from  or  nearer  to  the  retina.  I  will  quote 
him  in  full : 

We  have,  then,  the  ligament  by  which  the  ciliary  body  is 
attached  to  the  sclerotica;  the  outer  ciliary  muscle  to  contract 
the  vessels  returning  from  the  ciliary  processes;  the  ciliary 
processes,  which  are  attached  by  the  filaments  of  Ammon  to 
the  ciliary  zone  and  crystalline  capsule,  to  become  erect  and 
draw  forward  the  crystalline  body;  and  the  inner  ciliary  mus- 
cle, aided  by  the  elasticity  of  the  membrane  of  the  vitreous 
humor,  to  draw  it  backwards. 

The  functions  of  the  various  parts  of  the  ciliary  body  are 
evident  from:  1,  Its  entire  absence  when  there  is  another  in- 
strument for  adjustment;  2,  its  structure;  3,  there  is  no 
other  arrangement  by  which  adjustment  can  be  explained,  or 
by  which  we  can  account  for  the  sudden  occurrence  of  near 
and  far-sightedness. 

If,  when  the  eye  is  adjusted  to  a  remote  object,  we  direct 
it  by  the  external  muscles  to  one  which  is  near,  an  indistinct 
image  of  the  latter  is  formed  on  the  retina;  the  impression  is 
communicated  to  the  sensorium  by  the  optic  nerve;  a  reflex 
affection  of   the   third,  from   which  the  ciliary  nerves  in   part 


OPHTHALMOLOGY  IN  AMERICA.  129 

proceed,  causes  the  ciliary  muscle  to  contract,  the  processes  to 
become  erect,  and  the  crystalline  body  to  be  drawn  forward 
until  a  distinct  imajje  of  the  object  is  formed  on  the  retina. 

The  following  facts  show  that  the  eye,  in  a  perfectly  passive 
state,  is  adjusted  for  the  discernment  of  distant  objects:  1, 
An  effort  is  necessary  to  look  at  near  objects  without  fatigue; 
2,  as  age  advances,  the  ability  to  see  near  objects  becomes 
lessened,  while  distant  objects  can  be  seen  as  plainly  as  ever; 
and,  3,  when  under  the  relaxing  power  of  belladonna,  the  eye 
loses  the  power  of  seeing  near  objects  distinctly. 

By  the  graduating  power  of  the  ciliary  processes  and  ciliary 
muscles,  together  with  the  elasticity  of  the  membranes  of  the 
vitreous  body,  the  crystalline  may  be  drawn  not  only  back- 
wards and  forwards,  but  its  inclination  may  be  changed  so  as 
to  throw  the  image  on  another  part  of  the  retina.  As  the 
upper  and  outer  portion  of  the  ciliary  body  is  the  broadest, 
that  margin  of  the  crystalline  will  advance  the  furthest,  and 
thus  facilitate  the  vision  of  near  objects  with  both  eyes  at  the 
same  time.^' 

Had  Wallace  accompanied  his  otherwise  intelligent 
experiments  with  a  study  of  the  catoptric  images  from 
the  surfaces  of  the  lens  and  noted  their  curvature- 
changes,  he  would  undoubtedly  have  anticipated  von 
Helmholtz  by  many  years  and  arrived  at  the  correct 
mechanism  of  accommodation,  which  does  consist  in  the 
action  of  the  ciliary  muscle  on  the  crystalline  lens,  but 
to  change  its  surface  curvatures,  and  not  to  change  its 
position. 

OPHTHALMOLOGY    SHAKES    WITH    GENERAL    SURGERY    TX 
MANY  IMPROVEMENTS  AND  DISCOVERIES. 

While  ophthalmology,  both  from  the  scientific  and 
practical  standpoints,  has  been  simultaneously  advanced 
by    the    numerous    discoveries    and    greatly    increased 

37.  The  Accommodation  of  the  Eye  to  Distances,  1850,  p.  23. 


130  OPHTUAL.UOLOay  IX  AMERICA. 

knowledge  in  general  snrgerv.  vet  I  will  take  the  time  to 
refer  to  but  two  American  contributions  which  were 
made  previous  to  1850.  and  which  have  proved  to  be  so 
advantageous  in  ophthalmic  surgery  and  in  its  advance- 
ment.    My  first  reference  is  to 

AXIMAL    LIGATURES. 

I  need  not  discuss  the  value  of  animal  ligatures  in 
certain  operations  on  the  eye  and  its  appendages.  All 
will  agree  that  it  is  very  great.  The  credit  of  suggest- 
ing and  demonstrating  the  advantages  of  such  ligatures 
in  surgical  practice  belongs  to  an  American  surgeon, 
Dr.  Phillip  Syng  Physick,  of  Philadelphia.  The  story 
of  Dr.  Physick's  adoption  of  the  use  of  animal  ligatures 
is  best  told  by  Dr.  Frederick  P.  Henry ^^  as  follows : 

In  the  Eclectic  Repertory,  1816,  vol.  vi,  p.  389.  there  is  a 
letter  from  Dr.  Physick,  in  which  he  speaks  of  the  delay  in 
the  healing  of  wounds  because  of  the  ligatures  in  use.  He 
says:  "Several  j'ears  ago,  recollecting  how  completely  leather 
straps,  spread  with  adhesive  plaster  and  applied  over  wounds, 
for  the  purpose  of  keeping  their  sides  in  contact,  were  dis- 
solved by  the  fluids  discharged  from  the  wound,  it  occurred 
to  me  that  ligatures  might  be  made  of  leather,  or  of  some 
other  animal  substance,  with  which  the  sides  oi  a  blood  ves- 
sel could  be  compressed  for  a  sufficient  time  to  prevent  hemor- 
rhage, and  that  such  ligatures  would  be  dissolved  after  a  few- 
days  and  would  be  evacuated  with  the  discharge  from  the 
cavity  of  the  wound."  He  requested  Dr.  Dorsey  to  try  such  a 
ligature  on  a  horse,  and  the  result  justified  his  anticipations. 
The  letter  goes  on  to  say  that,  acting  on  Dr.  Physick's  sugges- 
tion. Dr.  Hartshorne  had  used  ligatures  made  of  parchment  on 
some  of  the  arteries,  after  an  amputation  of  the  thigh,  and 
they  were  found  dissolved  at  the  first  dressing.     Dr.  Dorsey, 

38.  Standard  History  of  the  Medical  Profession  of  Philadelphia, 
1897,  p.  486. 


OPHTHALMOLOGY  IN  AMERICA.  131 

with  Dr.  Phj^sick's  assistance,  used  French  kid  ligatures  with 
success  in  several  cases.  He  experimented  with  different  sub- 
stances to  ascertain  which  would  withstand  the  solvent  power 
of  the  pus  for  the  longest  time,  by  applying  the  material  over 
the  surfaces  of  ulcers.  Buckskin  and  kid  dissolved  first,  then 
parchment,  lastly  the  catgut.  Fearing  that  the  leather  might 
dissolve  too  soon  ''n  tying  large  vessels,  he  intended  to  re- 
quest Dr.  Dorsey  to  use  leather  impregnated  with  the  varnish 
used  in  making  elastic  catheters.  In  his  letter  he  makes  the 
suggestion  that  perhaps  tendon  would  be  found  more  durable 
than  any  of  the  materials  above  mentioned. 

Further  historical  details  are  given  in  the  American 
Mediml  Recorder,  1819^  vol.  ii,  p.  488,  and  the  Philadel- 
phia Journal  of  the  Medical  and  Physical  Sciences,  1821, 
vol.  ii,  p.  4. 

GENERAL   ANESTHESIA. 

The  other  contribution,  and  undoubtedly  the  most 
important  to  surgery,  is  general  anesthesia.  This,  too, 
is  emphatically  of  American  origin.  The  history  has 
been  so  often  told  that  I  need  only  refer  to  a  few  facts 
in  connection  with  it  at  this  time.  The  first  man  to 
use  sulphuric  ether  as  an  anesthetic  was  Dr.  Crawford 
W.  Long  of  Jefferson,  Jackson  County,  Ga.,  in  March, 
1842.  He  had  graduated  from  the  University  of  Penn- 
sylvania in  1839,  and  had  spent  one  year  after  this  in 
a  Xew  York  Hospital.  His  use  of  ether  was  the  out- 
come of  the  knowledge  of  effects  derived  from  its  in- 
halation as  a  matter  of  amusement.  His  experiments, 
which  were  prosecuted  in  a  perfectly  scientific  manner, 
demonstrated  that  the  operations  which  he  performed 
under  its  influence  were  done  without  pain  or  disagree- 
able reaction  to  the  patient.  His  first  operation  was 
performed  on  March  30,  1842,  and  consisted  in  the  re- 
moval of  a  small  cystic  tumor  of  the  jaw.    His  second 


132  OPHTHALMOLOGY  IN  AMERICA. 

operation  was  on  the  same  patient  on  June  6.  1842,  for 
the  removal  of  another  small  tumor.  His  third  case  was 
that  of  a  negro  boy  who  had  a  disease  of  a  toe  which 
rendered  its  amputation  necessary,  and  the  operation 
was  done  on  July  3,  1842.  Dr.  Long  continued  to  use 
sulphuric  ether  anesthesia  in  surgical  operations,  but, 
unfortunately,  he  does  not  seem  to  have  realized  what  a 
vast  benefit  this  discover}^  would  prove,  and,  being  a 
modest  country  practitioner,  he  did  not  publish  his  ex- 
perience until  1849."^  In  1852  he  read  a  paper  on  the 
subject  before  the  Georgia  Medical  Society,  in  which  he 
again  detailed  his  experience  with  ether  as  an  anesthetic. 
His  claims  to  priority  of  the  discovery  were  publicly  ad- 
mitted by  Dr.  Charles  T.  Jackson  in  1861  in  the  Boston 
Medical  and  Surgical  Journal  of  April  11,  that  year. 

Another  claimant  for  the  early  administration  of  sul- 
phuric ether  as  an  anesthetic,  according  to  Professor 
Lyman  in  his  work  on  "Anesthesia,'^  (p.  6)  was  the  late 
Dr.  W.  E.  Clark,  of  Chicago,  111.,  who.  while  a  student 
in  Dr.  E.  M.  Moore's  office,  Eochester,  X.  Y..  in  the 
winter  of  1842,  administered  ether  to  a  young  woman 
for  the  extraction  of  a  diseased  tooth,  which  was  done 
with  the  patient  in  an  unconscious  state.  Dr.  Moore 
believed,  however,  that  the  unconsciousness  was  hyster- 
ical, and  advised  his  pupil  to  make  no  more  experi- 
ments in  that  direction,  and  the  advice  was  unfortu- 
nately followed. 

It  remained  for  Dr.  W.  T.  G.  Morton,  later,  to  redis- 
cover the  anesthetic  properties  of  sulphuric  ether  and  to 
bring  the  agent  to  the  attention  of  the  public  in  the 
form   of    a    proprietary    preparation    which    he    named 

:iO.   Southern   Medical   Surgical   Journal.   December,   1849. 


DR.  W.  T.  C.  MORTON   (1819  186^8), 


DR.  JOHN  COLLINS  WARREN   (1778-1856). 


OPHTHALMOLOGY  IN  AMERICA.  137 

"letheon ;"  and.  so  far  as  the  professional  world  is  con- 
cerned, sulphuric  ether  anesthesia  had  its  real  birth  in 
the  Massachusetts  General  Hospital  on  Oct.  16.  1846, 
at  the  hands  of  its  originator.  Dr.  W.  T.  G.  Morton, 
and  under  the  knife  of  that  progressive  and  distinguished 
Boston  surgeon,  Dr.  John  Collins  Warren.  As  is  well 
known,  the  news  of  this  demonstration  of  sulphuric  ether 
anesthesia  spread  rapidly  throughout  the  world.  It  led 
Sir  James  Y.  Simpson  to  use  chloroform  anesthesia  at 
Edinburgh  the  following  year,  and  from  that  time  till 
now  general  anesthesia  has  been  a  priceless  boon  and  a 
most  powerful  factor  in  that  surgical  advancement  in 
which  ophthalmology  has  taken  a  proportionate  share. 
The  extent  of  the  progress  which  it  has  furthered  can  not 
be  measured  or  even  imagined.  I  need  not  undertake  to 
picture  any  of  the  benefits  which  operative  and  experi- 
mental ophthalmology  has  derived  from  it.  It  will  suf- 
fice to  say  that  America  would  have  glorified  herself  in 
ophthalmology  as  well  as  in  general  surgery  had  this 
been  her  onlv  contribution. 


VJ. 

THE    TRANSITION-PERIOD    FROM    THE    OPHTHALMOL- 
OGY OF  THE  PHYSICIAN  AND  SURGEON  TO  THE 
OPHTHALMOLOGY   OF   THE   SPECIALIST. 

The  imperfect  review  which  I  have  now  given  of  the 
ophthalmology  of  America  from  1800  to  1850,  of  its 
institutions,  of  the  men  who  were  most  alive  to  its 
interests,  of  the  surgeons  who  incidentally  made  it  a 
part  of  their  teachings  and  practice,  and  of  its  litera- 
ture and  contributions,  shows  what  growth  can  be  ob- 
tained, what  developments  can  be  made,  what  last- 
ing foundations  can  be  laid  in  the  midst  of  an  en- 
vironment whose  professional  standards  averaged  low, 
whose  professional  life  in  a  new  country  was  a  struggle 
for  bread,  whose  professional  sentiments  were  opposed  to 
specialism,  looking  upon  it  as  disgraceful,  and  in  which 
a  certain  amount  of  apathy  toward  ophthalmolog}'  was 
always  present. 

Isaac  Hays  and  his  co-workers  had,  notwithstanding 
all  these  hindrances,  supplied  foreign  and  original  liter- 
ature which,  at  the  opening  of  the  second  half  of  the 
nineteenth  century,  impressed  the  American  profession 
with  the  value  and  respectability  of  this  special  science, 
and  the  special  institutional  activities  had  demonstrated 
its  public  as  well  as  private  needs  and  benefits.  More 
and  more  had  a  few  of  our  physicians  and  surgeons  in 
our  large  cities  been  extending  their  practices  into  this 
special  field.    James  Edward  Cornell.  Mark  Stephenson, 


OPHTHALMOLOGY  IN  AMERICA.  139 

George  Wilkes,  Freeman  J.  Bumstead,  Henry  B.  Sands 
and  David  L.  Eogers,  of  Xew  York;  George  Hayward. 
Robert  W.  Hooper.  Francis  P.  Sprague,  John  H.  Dix 
and  George  A.  Bethime,  of  Boston;  Adinell  Hewson, 
Samuel  D.  Gross,  William  Hunt,  Edward  Hartshorne, 
A.  D.  Hall,  Thomas  G.  Morton,  Henry  H.  Smith,  John 
Neill,  D.  Hays  Agnew  and  R.  J.  Levis,  of  Philadelphia ; 
Aaron  Friedenwald  and  Nathan  R,  Smith,  of  Balti- 
more; J.  S.  Hildreth  and  Moses  Gunn,  of  Chicago; 
Simon  Pollak,  William  Dickinson,  John  T.  Hodgen, 
Paul  F.  Eve  and  Charles  A.  Pope,  of  St.  Louis;  Rob- 
ert A.  Kinloch,  of  Charleston;  Julius  F.  Miner,  of 
Buffalo,  and  Alden  March,  of  Albany,  and  probably 
many  others  whom  I  do  not  recall,  had  been  greatly 
skilled  in  it,  if  not  foremost  in  its  practice,  and  their 
prestige  had  eo  dignified  it  that  it  needed  only  the 
slightest  reaction  from  abroad  to  establish  it  as  an 
exclusive  department  of  medicine  here.  This  reaction 
was  imminent,  and  this  specialism  was  soon  to  be  an  ac- 
complished fact 


VII. 

THE  PIOSEER  SPECIALISTS. 

HEXRY   W.   WILLIAMS. 

The  first  American.  I  believe,  to  set  himself  to  ex- 
clusively special  study  in  Europe  was  Dr.  Henry  W. 
Williams  (1821-1895),  of  Boston.  He  had  begun  his 
medical  studies  at  Harvard  in  1844.  but  it  appears  that 
before  graduating  he  went  to  Europe^  where  he  spent 
three  years,  returning  in  1849.  In  the  same  year  he 
received  his  M.D.  degree  from  Harvard.  While  in 
Europe  he  took  a  systematic  course  in  ophthalmology 
at  the  then  famous  clinics  of  Sichel  and  Desmarres,  of 
Paris,  also  following  the  services  at  Vienna  of  Frederich 
Jaeger  and  Rosas,  and  at  London  of  Dalrymple,  Law- 
rence, Dixon,  Critchett  and  Bowman.  It  was  too  early 
to  study  with  von  Graefe,  von  Helmholtz  and  Donders. 
for  they  were  just  entering  on  their  life  work.  On  his 
return  to  Boston,  he  was  appointed  one  of  the  district 
physicians  of  the  Boston  Dispensary,  and  in  1850  waj 
made  its  first  ophthalmic  surgeon.  In  the  same  year 
he  organized  a  class  of  Harvard  medical  students  for 
instruction  in  diseases  of  the  eye,  in  which  he  was  great- 
ly aided  by  his  lifelong  friend.  Dr.  Charles  E.  Bucking- 
ham, who  for  several  years  placed  at  his  disposal  a  very 
abundant  and  excellent  clinical  material  at  the  ^^Old 
City  Institution"  in  South  Boston.  In  1864  Dr.  Wil- 
liams was  made  ophthalmic  surgeon  to  the  City  Hos- 
pital, a   position  which  he  held   for  many  years.     In 


DR.  HENRY  W.  WILLIAMS    ( 1821-189.j). 


OPHTHALMOLOGY  IN  AMERICA.  143 

1869  he  was  made  lecturer  on  ophthalmology,  and  in 
1871  professor  of  ophthalmology  in  Harvard  Medical 
College.  It  is  said  that  his  teaching  was  lucid  and 
practical,  and  was  always  admirably  suited  to  the  just 
requirements  of  the  particular  class  of  hearers,  whether 
physicians  or  students,  to  whom  it  was  addressed. 

Through  the  long  succession  of  ophthalmic  internes 
and  externes  under  him  at  the  City  Hospital,  and  the 
many  classes  of  students  taught  by  him  at  the  medical 
college,  also  through  the  numerous  editions  of  his  books, 
which  were  bought  and  studied  by  physicians,  he  ex- 
erted a  continuing  and  far-reaching  influence. 

As  an  ophthalmologist.  Dr.  Williams  won  favorable 
recognition  from  the  first  years  of  his  practice  as  a  physi- 
cian in  1850.  He  was  identified  with  this  specialty 
from  the  beginning  of  a  professional  career  which  ex- 
tended through  forty-six  years,  and,  although  a  special- 
ist of  high  rank,  he  never  gave  up  his  interest  in  general 
medicine  or  in  subjects  of  public  interest. 

Throughout  the  whole  of  his  professional  life  Dr.  Wil- 
liams showed  himself  at  once  conservative  and  inde- 
pendent. A  careful  observer  of  the  work  of  others,  he 
possessed  in  a  high  degree  the  faculty  of  discrimination 
in  respect  to  the  relative  merits  of  teachers  and  the 
value  of  their  particular  methods.  Learning  from  all, 
he  owed  no  partisan  allegiance  to  any  single  master  or 
school. 

The  method  of  Daviel,  as  perfected  by  Beer,  was, 
with  unimportant  variations,  practiced  by  all  the  great 
masters  of  the  art  with  a  deftness  and  finish  which  have 
never  been  rivaled.  Influenced  by  such  examples,  it 
was  only  natural  that  he  should   adopt  extraction   in 


144  OPHTHALMOLOaY  I\  AMERICA. 

preference  to  the  brilliant  but  uncertain  operation  of 
reclination  then  in  vogue  in  this  country.  In  the  per- 
formance of  extraction  he  was  unexcelled,  and  it  is  char- 
acteristic of  the  man  that  he  never  departed  very  widely 
from  the  method  which  he  had  learned  to  practice  so 
well  and  which  he  believed  to  be,  on  the  whole,  the  most 
satisfactory  in  its  results.  He  adhered  to  the  classical 
flap  incision  long  after  the  peripheral  linear  section  of 
von  Graefe  had  been  generally  adopted,  and  steadfastly 
withstood  the  tidal  wave  of  opinion  in  favor  of  iridec- 
tomy as  an  integral  part  of  the  operation.  He  was  one 
of  the  first,  if  not  the  first,  among  ophthalmic  surgeons 
to  advocate  and  employ  etherization  as  a  general  prac- 
tice in  cataract  extraction. 

He  was  a  man  of  large  stature  and  strong  character, 
and  was  a  conspicuous  figure  on  all  medical  occasions. 
He  was  a  frequent  and  forcible,  but  persuasive,  speaker 
and  an  excellent  presiding  officer.  He  was  sturdy  and 
honest  in  suppressing  quackery,  and  in  a  thousand  ways 
left  his  mark  on  his  times  and  on  his  community.'*'^ 

ELKAXAH    WILLIAMS. 

Elkanah  Williams  ( 1822-1888 )  began  his  profes- 
sional life  a  little  later.  He  graduated  from  the  Uni- 
versity of  Louisville  in  1850.  After  engaging  in  general 
practice  for  a  short  time,  he  went  abroad  in  1852,  with 
the  avowed  purpose  of  studying  ophthalmology.  He 
followed  the  same  teachers  as  had  Henry  ^Y.  Williams 
at  Vienna,  Berlin,  Paris  and  London.  He  was  a  young 
man  of  intelligence  and  ambition,  and  he  fitted  himself 
for  ophthalmologic  practice  as  completely  as  possible. 

40.  From  biographical  sketch  by  Dr.  John  Green,  Trans.  'Am.  Oph. 
Sec,  1896,  vii,  479. 


DR.  ELKANAH  WII.LIAMS   (1822-1888), 


OPHTHALMOLOGY  IN  AMERICA.  147 

While  in  Europe  the  newly  invented  ophthalmoscope 
was  the  source  of  much  experiment  and  discussion.  He 
acquired  a  knowledge  of  its  use  in  its  modified  form  and 
was  probably  the  first  to  bring  an  instrument  to  this 
country  and  to  teach  his  American  colleagues  its  won- 
derful revelations.  It  is  said  that  he  was  also  the  first 
to  demonstrate  its  use  to  London  ophthalmologists  at 
Moorfields  in  1854.*^  They  had  previously  hesitated  to 
employ  it,  fearing  that  the  strong  light  which  was  re- 
flected by  it  into  the  eye  would  injure  the  retina.  To 
illustrate  the  sentiment  then  existing  in  London  I  will 
quote  from  Mr.  James  Dixon,  who  was  then  one  of  the 
most  prominent  ophthalmologists  in  England,  and  who 
was  one  of  the  surgeons  to  the  Moorfields  Eye  Hospital. 
In  1853  he  said  :*-  ^Tf  the  praise  bestowed  on  this  in- 
strument (the  ophthalmoscope  of  Coccius)  be  allowed 
to  go  forth  to  the  professional  public  without  strong 
cautions  and  limitations,  such  dangerous  results  appear 
to  me  likely  to  ensue  that  I  feel  it  a  duty  to  offer  a 
few  remarks  on  the  subject  for  the  consideration  of  your 
readers.'^  The  practitioner  in  using  the  ophthalmoscope 
"may  bring  about  the  very  condition  (amaurosis)  that 
he  is  hoping  to  avert.'^  Later  he  also  said*^  that  he 
retained  "a  very  strong  opinion  as  to  the  mischief  likely 
to  result  from  the  abuse  of  the  reflecting  ophthalmo- 
scope if  it  is  indiscriminately  resorted  to  by  inex- 
perienced persons  for  investigating  cases  hastily  classed 
as  incipient  amaurosis." 

Dr.  Williams,**  in  an  article  on  the  ophthalmoscope, 
— _ — . ) 

41.  London  Medical  Times  and  Gazette,  vol,  ix,  p.  30,  1854. 

42.  The  London  Medical  Times  and  Gazette,  vol.  vii,  1853,  p.  379. 

43.  Ibid.,  vol.  ix,  1854,  p.  7. 

44.  The  London  Medical  Times  and  Gazette,  vol.  ix,  1854,  p.  30. 


148  OPHTUALMOLOCrY  IX  AMERICA. 

contributed  in  1854.  modestly  referred  to  his  use  of  the 
instrument  in  the  Moorfields  (Royal  London  Ophthal- 
mic) Hospital,  where  he  probably  demonstrated  its 
harmlessness^  as  well  as  benefits,  with  convincing  effect. 
He  said :  "As  examples  are  always  more  interesting  and 
instructive  than  general  descriptions,  I  will  give  a  short 
account  of  some  cases  which  I  have  had  occasion,  within 
the  last  few  weeks,  to  observe  at  the  London  Ophthalmic 
Hospital  in  the  presence  of  Mr.  Dixon  and  Mr.  Bowman, 
who  had  themselves  seen  some  of  the  alterations  which 
it  is  my  object  now  to  describe.  It  is  with  great  pleas- 
ure that  I  take  this  opportunity-  of  thanking  the  eminent 
surgeons  of  the  institution  for  the  kind  permission  they 
have  granted  me  of  attending  their  extensive  and  inter- 
esting 2)ractice,  and  especially  of  continuing  those  ob- 
servations with  the  ophthalmoscope  which  I  had  com- 
menced at  Paris  with  Dr.  Anagnostakis,  the  ingenious 
inventor  of  the  ophthalmoscope  which  I  use."  Then 
follows  a  description  of  the  cases  in  which  he  had  used 
this  instrument  and  of  the  appearances  which  they  pre- 
sented. 

On  his  return  to  Cincinnati,  in  1855.  Dr.  Williams  at 
once  established  an  eye  clinic  in  connection  with  one  of 
the  hospitals,  which  met  with  success.  In  1860  Miami 
Medical  College,  which  was  organized  in  1852,  created 
a  chair  of  ophthalmology,  and  Dr.  Williams  was  elected 
professor  to  it.  This  was  the  first  time  in  America  that 
a  medical  college  had  thus  recognized  this  specialty. 

Dr.  Williams  was  a  lucid  and  impressive  teacher,  and 
was  greatly  beloved  by  both  physicians  and  students. 
For  a  number  of  years  he  had  editorial  charge  of  the 
Cincinnati  Lancet  and  Observer,  and  contributed  nu- 


OPHTHALMOLOGY  IN  AMERICA.  149 

merous  articles  and  reports  on  ophthalmologic  subjects 
to  its  columns.  In  1885  he  wrote  the  section  on  dis- 
eases and  injuries  of  the  eye  for  Ashurst's  International 
Enclvconedia  of  Surgery,  1884,  vol.  v,  pp.  169-288.  It 
was  concise  and  comprehensive ;  in  fact,  it  was  a  com- 
plete manual  on  the  subject  and  embodied  the  results  of 
his  own  observations  and  experience  of  many  years^  dura- 
tion. As  a  teacher,  practitioner  and  operator  he  had 
few  equals. 

THE  IXFLUEXCE  OF  THE  TWO  WILLIAMSES. 

These  two  men,  Henry  W.  Williams,  of  the  East,  and 
Elkanah  Williams,  of  the  West,  inspired  by  the  examples 
of  their  famous  European  teachers  and  believing  in  the 
dignity  and  value  of  specialism,  dared  to  assert  them- 
selves in  opposition  to  an  organized  and  inbred  senti- 
ment against  it.  By  their  professional  loyalty  and  up- 
rightness, by  their  devotion  to  the  interests  of  general 
medicine,  by  their  enthusiasm  and  consistent  aggres- 
siveness, by  their  learning  and  their  skill,  and  by  their 
kindly  and  commanding  personality,  they  won  the  battle 
for  the  exclusive  practice  of  ophthalmology. 

With  the  examples  and  labors  of  these  two  men,  and 
with  the  growing  interest  in  ophthalmology  that  had 
already  developed,  the  impulse  became  irresistible  and 
the  time  seemed  to  have  arrived  for  men  to  build  anew 
on  the  foundations  which  a  half  century  had  made 
secure.  Other  young  men  began  to  repair  to  the  large 
eye  clinics  of  Europe,  and  they  continued  to  bring  back 
to  this  country  the  enthusiasm  of  the  great  masters  and 
a  greatly  enlarged  view  of  ophthalmology. 


YIII. 

Jiy  ERA  OF  RAPID  CHAXGE,  AFTER  1850. 

While  this  interest  was  deepening  and  widening  in 
this  country,  great  changes  were  also  taking  place 
abroad.  In  1851  von  Helmholtz  published  his  invention 
of  the  ophthalmoscope;  in  1854  von  Graefe  established 
his  Archives;  in  185T  Streatfield  began  the  publication 
of  the  Royal  London  Ophthalmic  Hospital  Reports;  in 
1857  von  Graefe  startled  the  world  by  the  announce- 
ment of  a  surgical  remedy  for  glaucoma;  in  1857  to 
1859  Bonders  recorded  in  von  Graefe's  Archives  his 
marvelous  researches  in  the  refraction  and  accommoda- 
tion of  the  eye  and  their  anomalies. 

During  the  '50s  the  important  accessions  to  the  spe- 
cial literature  were  Dr.  H.  W.  Williams'  translation,  in 
1850.  of  Dr.  SicheFs  work  on  "Spectacles."  and  new 
editions  of  English  treatises  on  the  eye  and  its  diseases. 
In  1853  Lindsay  and  Blakiston,  of  Philadelphia,  issued 
"A  Treatise  on  Operative  Ophthalmic  Surgery,"  by  H. 
Hayes  Walton,  F.E.C.S.E.,  of  London,  England,  edited 
by  S.  Littell,  M.D.,  of  Philadelphia.  It  was  the  first 
American,  from  the  first  London  edition,  in  an  octavo 
volume  of  599  pages,  illustrated  by  169  engravings.  As 
indicated  by  the  title,  the  range  of  the  work  was  limited 
to  operative  ophthalmic  surgery,  and  within  that  range 
it  was  a  valuable  contribution  to  our  science.  It  was 
the  first  work  on  the  eye  to  contain  a  chapter  on  general 
anesthesia  in  this  department  of  surgical  practice.    The 


DR.    ADINELL    HEWSON     (1828-1889), 


OPHTHALMOLOGY  IN  AMERICA.  153 

author  preferred  chloroform  to  sulphuric  ether  or  anv 
other  agent  in  producing  the  anesthesia.  He  believed 
that  it  might  be  administered  to  "persons  of  all  ages, 
from  a  few  weeks  or  months  old  to  extreme  age."  He 
further  stated  that  "it  is  scarcely  possible  to  overrate  the 
value  of  a  discovery  which  tranquilizes  the  mind  of  the 
patient  by  banishing  the  anticipation  of  pain,  deadens 
the  sensibility,  and  prevents  the  reality  of  suffering; 
while  to  the  operator  it  brings  the  inestimable  advantage 
of  quieting  the  struggles  of  children,  or  of  irresolute 
adults,  which  are  so  apt  to  frustrate  all  the  care,  fore- 
sight and  dexterity  that  the  most  assiduous  application 
to  practical  surgery  can  command." 

In  1854  another  edition  of  the  great  work  of  Law- 
rence was  republished  here,  much  enlarged  and  im- 
proved by  Dr.  Havs.  His  notes  were  numerous  and 
valuable. 

The  next  year,  1855,  Dr.  Adinell  Hewson  brought  out 
a  new  American  edition  of  William  Mackenzie's  ency- 
clopedic "Practical  Treatise  on  Diseases  of  the  Eye." 
His  additions,  too,  were  numerous  and  valuable.  They 
included  new  suggestions,  as  well  as  recent  observations, 
and  for  the  first  time,  in  an  American  book,  he  de- 
scribed the  ophthalmoscope  by  adding  a  special  chapter 
devoted  to  it.  This  instrument  had  been  entirely  ignored 
in  the  English  edition. 

In  1856  there  was  another,  the  second  American, 
edition  of  T.  Wharton  Jones'  "Principles  and  Practice 
of  Ophthalmic  Medicine  and  Surgery"  (Philadelphia 
Lea  and  Blanchard,  1856).  This  time  it  was  edited  by 
Dr.  Edward  Hartshorne  instead  of  by  Dr.  Hays.  Dr. 
Hartshorne  was  a  distinguished  practitioner  of  Philadel- 


154  OPHTHALMOLOGY  I\  AMERICA. 

phia  and  was  prominent  there  in  ophthalmic  circles.  His 
notes  added  materially  to  the  value  of  the  book. 

The  '60s  became  more  prolific  than  ever  before,  at 
least  of  foreign  literature  on  the  eye,  and  its  influence 
on  America  was  deeper  and  more  lasting.  In  1864  the 
classic  work  of  Donders  on  "Refraction  and  Accommo- 
dation"' was  put  into  English,  and  in  1866  and  1867 
that  of  von  Helmholtz  on  "Physiological  Optics"  was 
issued  both  in  German  and  in  French.  Immediately 
aft^r  these  publications  J.  Soelberg  Wells,  of  London, 
wrote  his  extended  "Treatise  on  Diseases  of  the  Eye," 
accepting  and  incorporating  the  conclusions  of  Donders 
and  von  Helmholtz,  together  with  the  operative  proce- 
dures of  von  Graefe  in  glaucoma  and  cataract.  Wells' 
work  epitomized,  also,  the  new  experiences  and  conclu- 
sions of  his  English  confreres,  Critchett,  Bowman  and 
others.  In  fact,  it  was  the  reflection  of  all  that  was 
new  in  ophthalmology',  and  at  the  same  time  embodied 
the  verities  of  the  old.  It  was  published  in  London  in 
1868  and  in  this  country  in  1869.  E.  Jaeger,  in  1869, 
also  published  that  inimitable  "Atlas,"  representing  the 
normal  and  pathologic  fundus  of  the  eye,  the  descrip- 
tive text  being  in  German.  It  was  followed  the  next 
year  by  a  French  edition,  by  de  Wecker,  of  Paris. 

Another  work  of  great  erudition  and  merit  was  thai 
of  Stellwag  von  Carrion.     It  was  issued  in  German  in 

1867  and  was  at  once  translated  into  English  by  Drs. 
Eoosa,  Bull  and  Hackley  of  Xew  York  and  published  in 

1868  by  William  Wood  &  Co.,  Xew  York.  In  the  mean- 
time translations  of  foreign  ophthalmologic  articles  were 
published  in  the  Boston,  Xew  York  and  other  journals, 
either  in  full  or  in  abstract,  by  Hasket  Derby,  Henry  D. 
Xoves  and  others. 


DR.    EDWARD    HARTSHORNE    (1818-1885). 


OPHTHALMOLOGY  IN  AMERICA.  157 

Dr.  H.  W.  Williams  in  1862  published  his  "Practical 
Oiiicle  4:0  the  Study  of  Diseases  of  the  Eye/'  a  12mo  of 
351  pages.  This  was  the  feurth  original  work  on  dis- 
eases of  the  eye  written  by  an  American,  and  in  its 
clearness  and  conciseness,  and  yet  completeness,  has 
never  been  excelled.  Eepresenting,  as  it  did,  the  oph- 
thalmology of  that  tinie^  the  publication  of  Dondera' 
work  in  1864  made  it  necessary  to  give  it  an  early  re- 
vision. It  passed  through  several  editions,  the  last  of 
which  was  issued  in  1886,  and  to-day,  even,  is  a  model 
of  medical  authorship.  In  1865  Dr.  Williams  was  the 
successful  competitor  for  the  Boylston  prize,  the  subject 
being  "Recent  Advances  in  Ophtliahnic  Science."  This 
was  published  in  uniform  style  witli  his  "Practical 
Guide/'  making  a  12mo  of  178  pages.  The  substance 
of  this  essay  was  afterwards  incorporated  into  his  "Prac- 
tical Guide/'  but  in  itself  alone  it  was  an  important  ad- 
dition to  the  ophthalmic  literature  of  that  time. 

*  THE  OPHTHALMOSCOPE. 

Soon  after  the  discovery  of  the  ophthalmoscope  much 
interest  was  shown  in  this  instrument  in  this  country, 
and  numerous  articles  were  written  describing  it  and  its 
uses.  Among  the  earliest  of  tl'.ose  who  wrote  on  the 
subject  were  George  A.  Bethune,  of  Boston;'*''  John  H. 
Dix,  of  Boston  :"*"  Adinell  Hewson,  of  Philadelphia;"*' 
Montrose  A.  Pallen.  tlien  of  New  York."*^  and  L.  Turn- 
bull,  of  Philadelphia.-"^ 

45.  Boston  Med.  and  Surg.  Jour.,  18r)4.  vol.  ii. 

46.  Boston  Med.  and  Surg.  Jour,  for  I8.I0.  ISoV,  and  1858. 

47.  Am.   Ed.  of  Mackenzie,  18.5.">. 

48.  Trans.  Am.   Med.   Assn.,  18.18. 

49.  I'hila.  Med.   and  Surg.  Reporter,  1859. 


158  OPHTHALMOLOGY  IX  AMERICA. 

TWO   XOTABLE  ARTICLES. 

Two  original  articles  which  were  especially  notable, 
both  by  the  Williamses.  were  published  during  the  early 
part  of  this  formative  period.  One  was  by  Henry  W. 
Williams  "On  the  Treatment  of  Iritis  Without  Mer- 
cury,'* in  1856.  It  was  a  memorable  essa}',  and  is  said 
to  have  inaugurated  a  radical  reform  in  the  therapeu- 
tics of  that  disease.  Dr.  Williams  demonstrated  by  the 
study  of  sixt3'-four  cases  that  this  class  of  cases  would 
recover  by  the  systematic  use  of  a  strong  solution  of 
atropia,  the  only  internal  remedies  administered  being 
iodid  of  potassium,  colchicum  and  iron. 

The  other  paper  was  by  Elkanah  Williams  ''On  the 
Obliteration  of  the  Lachrymal  Sac  by  the  Actual  Cau- 
tery." It  was  first  presented  in  Cincinnati  in  1856 
(Cincinnati  Lancet  and  Observer,  1856).  and  again  be- 
fore the  International  Congress  of  Ophthalmology  in 
1862.^'^ 

TWO   NEW   EYE  HOSPITALS. 

During  the  same  period  two  new  institutions  devoted 
to  the  charitable  relief  of  the  poor  afflicted  with  diseases 
of  the  eye  were  added  to  those  previously  founded. 

The  first  was  the  Xew  York  Ophthalmic  Hospital, 
which  was  incorporated  April  21,  1852,  and  was  opened 
on  May  25  of  the  same  year.  The  board  of  directors 
was  made  up  of  prominent  citizens  of  Xew  York  City, 
and  Hon.  C.  S.  Woodhull  was  its  first  president.  The 
first  surgeons  were  Dr.  David  L.  Rogers  and  Dr.  Mark 
Stephenson,  both  of  Xew  York.  It  had  a  humble  be- 
ginning like  other  institutions  of  the   kind,   and   the 

50  Congres    Periodique    Internationale    d'Ophthalmologie,  2e    ses- 
sion,  1862.     Compte-rendu.  Paris.   1863,  p.   137. 


DK.  EDWARD  L.  HOLMES    (1828-1900), 


OPHTHALMOLOGY  IN  AMERICA.  161 

purpose  of  its  organization  was  said  to  be  to  accommo- 
date the  poor  in  districts  then  farther  up  town  in  that 
cit}'.  Its  first  location  was  at  Xo.  6  Stuyvesant  Street, 
between  Second  and  Third  Avenues.  According  to  its 
first  report,  four  hundred  and  forty-four  patients  were 
treated  from  May  25,  1852,  to  Jan.  1,  1853.  From  that 
time  it  had  a  steady  and  healthful  growth.  In  1865 
the  surgical  staff  was  constituted  of  Drs.  John  P.  Gar- 
rish,  Marcus  P.  Stephenson,  William  F.  Ilolcomb, 
Ebenezer  McFarland,  Giovinni  Ceccarini  and  John  M. 
Carnochan,  with  Drs.  David  L.  Rogers,  Alfred  C.  Post 
and  Frank  H.  Hamilton,  consultants.  Almost  from 
the  outset  clinical  instruction  on  diseases  of  the  eye  was 
given  to  students,  and  in  1865,  the  report  states  that 
"over  six  hundred  students  have  availed  themselves  of 
these  advantages." 

In  1867  the  homeopaths  in  some  way  secured  posses- 
sion of  the  management,  and  since  then  it  has  been 
served  by  homeopathic  practitioners.  To-day  it  is  es- 
timated that  about  15,000  patients,  including  eye,  ear, 
nose  and  throat  cases,  are  treated  there  annually. 

The  other  institution  was  that  most  active  and  benef- 
icent one  of  Chicago,  known  to-day  as  the  Illinois  Char- 
itable Eye  and  Ear  Infirmary. 

In  the  month  of  May,  1858,  a  number  of  physicians, 
under  the  leadership  of  Dr.  Edward  L.  Holmes,  met 
some  benevolently  disposed  citizens  of  Chicago  and 
founded  the  Chicago  Charitable  Eye  and  Ear  Infirmary, 
electing  a  board  of  trustees  and  making  Dr.  Edward  L. 
Holmes  surgeon.  Its  first  location  was  in  a  single  room 
at  the  northeast  corner  of  Michigan  and  North  Clark 
Streets.    It  remained  there  until  1862,  when  it  was  re- 


102  (H'HTHALMOLOGY  IX  AMERICA. 

moved  to  Xo.  2S  Xorth  Clark  Street.  In  1864  Walter 
L.  Xewberry,  president  of  the  institution,  donated  for 
a  term  of  ten  years  the  lease  of  a  lot  of  land,  on  which 
was  erected  a  large  two-story  frame  building.  In  1865 
this  building  was  raised  and  a  brick  basement  con- 
structed under  it.  In  18T1  the  State  of  Illinois,  after 
some  preliminary  legal  proceedings,  received  it  into  the 
circle  of  state  institutions  by  a  special  act,  when  the 
name  of  the  institution  was  changed  by  the  substitution 
of  the  word  "Illinois''  for  "Chicago.''  "^On  Oct.  9,  1871, 
fire  swept  away  the  old  infirmary.  The  state  at  once 
made  provisions  for  carrying  on  the  work  of  the  institu- 
tion, and  as  soon  as  possible  erected  the  present  building, 
which  was  completed  in  1874.  The  number  of  patients 
of  all  kinds  admitted  to  the  infirmary  for  treatment  for 
the  biennial  period  ending  June  30,  1902  (the  last  re- 
port at  hand),  was  21,395,  making  a  total  at  that  time 
of  182,904  admitted  since  the  opening  of  the  institution 
by  the  state  in  1874. 

Among  the  active  surgeons  have  been  Edward  L. 
Holmes,  Edwin  Powell,  F.  C.  Hotz,  S.  J.  Jones  and 
others. 

OPHTHALMOLOGIC  JOURXALISM. 

Early  in  the  '60s  a  movement  was  made  to  establish 
an  ophthalmologic  journal.  This  deserved  to  be  a  last- 
ing success,  but  it  was  not.  There  had  never  been  an 
ophthalmologic  journal  in  this  country,  ophthalmologic 
papers  having  been  heretofore  published  in  the  general 
medical  journals  and  in  the  transactions  of  the  state 
societies  and  of  the  American  Medical  Association.  Dr. 
Julius  Homberger,  who  had  been  a  pupil  of  von  Graefe 
and  Sichel,  had  just  settled  in  Xew  York  to  practice 


DR.   HENRY  D.   NOYES    (1832-1900). 


OPHrHALMOLOGY  IW  AMERICA.  1G5 

ophthalmology.  The  time  seemed  to  him  auspicious  for 
establishing  a  special  journal.  In  1862,  therefore,  he 
undertook  to  do  so.  under  the  name,  The  American  Jour- 
nal of  Ophthalmology.  The  first  prospectus  announced 
that  it  would  be  a  quarterly  with  forty-eight  pages  to 
each  number.  The  first  number  was  issued  in  July, 
1862.  Six  numbers  were  published  between  that  date 
and  May,  1863  and  constituted  the  first  volume.  The 
second  volume  was  begun  in  January,  1864,  but  the  en- 
terprise was  apparently  discontinued  with  the  second 
number  of  this  volume,  in  April  of  that  year.  It  con- 
tained but  few  original  articles  and  these  were  mostly 
written  by  the  editor.  The  bulk  of  the  contents  was 
made  up  of  translations  of  articles  by  von  Graefe  and 
other  German  writers.  The  pages  were  closely  printed 
and  the  articles  represented  some  of  the  best  German 
thought. 

THE  AMERICAN  OPHTHALMOLOGICAL  SOCIETY. 

In  point  of  time  the  next  movement  to  create  a  means 
of  interchange  of  thought  and  experience  on  the  part 
of  the  few  Americans  who  were  engaging  themselves 
wholly  or  in  part  in  ophthalmic  study  and  practice  was 
instigated  by  two  enterprising  young  men.  Dr.  Henry  D. 
Noyes,  of  New  York,  and  Dr.  Hasket  Derby,  of  Boston, 
who  had  then  just  entered  on  careers  of  specialism.  They 
were  materially  aided  and  encouraged  by  Dr.  Freeman  J. 
Bumstead,  a  prominent  and  influential  general  as  well 
as  ophthalmic  surgeon  of  Xew  York.  In  response  to 
several  verbal  invitations,  a  conference  was  held  at  the 
office  of  Dr.  Noyes,  278  Fourth  Avenue,  New  York,  on 
Jan.  9,  1864.  The  purposes  of  the  conference  were 
stated  to  be  "to  consult  on  the  best  mode  of  promoting 


166  OPHTHALMOLOGY  IX  AMERICA. 

the  interests  of  ophthalmology  in  this  country.'^  Drs. 
H.  B.  Sands,  H.  Althof,  J.  H.  Hinton,  F.  J.  Bumstead, 
D.  B.  St.  John  Eoosa,  W.  F.  Holcomb,  H.  D.  Noyes,  all 
of  New  York,  and  Hasket  Derby,  of  Boston,  were  pres- 
ent. The  project  of  founding  a  journal  of  ophthalmol- 
ogy  was  discussed,  but  it  was  voted  down.^^  A  resolution, 
however,  presented  by  Dr.  Bumstead,  was  passed,  au- 
thorizing the  appointment  of  a  committee  "to  invite 
ophthalmic  surgeons  from  the  whole  country  to  assemble 
in  jSTew  York  at  the  time  of  the  meeting  of  the  Ameri- 
can Medical  Association."  Drs.  Bumstead,  Noyes  and 
Derby  were  appointed  such  committee.  Pursuant  to  a 
call  of  this  committee,  a  meeting  was  held  at  the  New 
York  Eye  Infirmary,  Second  Avenue  and  Thirteenth 
Streets,  on  June  7,  1864.  Eighteen  gentlemen  were 
present.  Dr.  Bumstead  called  the  meeting  to  order, 
and  Dr.  Edward  Delafield  was  elected  chairman  and  Dr. 
H.  D.  Xoyes  secretary.  A  constitution  and  by-laws 
were  adopted. 

At  the  meeting  held  the  next  day  papers  were  read 

51.  Since  the  above  was  put  in  type  I  have  received  the  fol- 
lowing note  from  Dr.  Hasket  Derby,  of  Boston,  which  is  self  ex- 
planatory. It  will  serve  to  indicate  the  opposition  that  was  felt 
toward  Dr.  Homberger  and  his  journal,  and  the  actuating  desire 
of  the  pioneer  ophthalmologists  to  neutralize  his  influence  and  to 
advance  ophthalmology  on  scientific  and  unselfish  lines.  Dr.  Derby 
says  :  "The  actual  founder  of  the  society  was  Dr.  Julius  Homberger, 
as  I  used  laughingly  to  assert,  to  Dr.  Noyes'  great  indignation. 
About  1862,  a  peripatetic  German  adventurer  of  this  name  came 
to  New  York  to  engage  in  ophthalmic  practice,  and  started  a  maga- 
zine of  ophthalmology.  After  a  few  numbers  this  probably  fell 
stillborn,  but  while  it  lasted  it  disgusted  reputable  ophthalmologists, 
and  the  meeting  called  by  Dr.  Noyes.  after  consultation  with  me. 
was  really  to  concert  measures  for  the  establishment  of  a  magazine 
that  should  be  respectable.  Eight  of  us  came  together  at  Dr. 
Noyes"  oflBce  in  Fourth  Avenue,  and  after  well  weighing  the  matter, 
decided  that  a  society  would  be  a  better  thing  to  found  than  a 
magazine.  So  we  issued  a  call  for  a  meeting  and  held  it  (the 
first)  June  7,  1864.  Thus  we  originated.  Whatever  became  of 
Homberger  I  have  no  means  of  knowing.  The  Germans  have  a 
word,  'verschollen,"  which  probably  applies  to  him." 


DR.    HASKET   DERBY. 


OPHTHALMOLOGY  IN  AMERICA.  169 

and  discussed  and  certain  other  business  was  transacted. 
The  organization  was  completed  and  named  The  Amer- 
ican Ophthalmological  Society.  Dr.  Edward  Delafield 
was  elected  president,  Dr.  Henry  D.  No3^es  recording 
secretary,  and  Dr.  Herman  xllthof  corresponding  secre- 
tary. As  an  indication  as  to  who  the  principal  ophthal- 
mic surgeons  were  in  18G4  I  will  here  record  those  who 
were  present  and  who  were  made  charter  members,  and 
also  those  who  were  not  present  but  who  were  elected  to 
membership:  Present,  Drs.  Edward  Delafield,  F.  J. 
Bumstead,  John  Hinton,  Francis  Simrock,  Herman  Alt- 
hof,  W.  F.  Holcomb,  D.  B.  St.  John  Eoosa,  William  F. 
Carmalt,  William  Stimpson,  Henry  B.  Sands,  Henry 
D.  Noyes,  of  New  York;  John  H.  Dix,  B.  Joy  Jeffries, 
Hasket  Derby,  Francis  P.  Sprague,  of  Boston;  Ezra 
Dyer,  of  Philadelphia,  and  C.  A.  Robertson,  of  Pough- 
keepsie.  Others  elected  to  active  membership  were  Drs. 
Abram  Du  Bois,  of  New  York;  Henry  W.  Williams, 
Gustavus  Hay,  of  Boston ;  J.  F.  Noyes,  of  Detroit,  J.  S. 
Hildreth,  of  Chicago;  Adinell  Hewson,  William  Hunt 
and  Thomas  G.  Morton,  of  Philadelphia.  The  follow- 
ing were  elected  honorary  members :  Drs.  Edward  Rey- 
nolds, Robert  W.  Hooper,  George  A.  Bethune,  John 
Jeffries,  of  Boston;  George  Wilkes,  of  New  York,  and 
Isaac  Hayes,  of  Philadelphia. 

Dr.  John  H.  Dix  was  the  first  to  read  a  paper  before 
the  newly  organized  society.  It  had  a  double  subject; 
one  part  was  the  report  of  a  case  of  "Peculiar  Trans- 
parent Neoplastic  Formation  in  the  Anterior  Chamber 
of  the  Eye,''  and  the  other  was  "On  the  Effects  of  Cal- 
abar Bean  on  Paralysis  of  Accommodation  Following 
Diphtheria." 


170  OPHTHALMOLOGY  IN  AMERICA. 

Thus  was  founded  the  first  ophthalmological.  society 
in  America,  if  not  in  the  world.  Thus  began  the  united 
scientific  labors  of  American  ophthalmic  surgeons,  and 
such  was  the  personnel  of  its  first  membership.  The 
transactions  of  the  society  from  186-i  to  1906  record 
the  essential  results  of  the  study  and  practice  of  these 
and  subsequent  members,  and  in  a  great  measure  repre- 
sent the  progress  of  ophthalmology  in  this  country  dur- 
ing the  last  forty  years. 

LOCAL    SOCIETIES. 

In  1864  the  Xew  York  (City)  Ophthalmological  So- 
ciety was  organized,  with  Dr.  Cornelius  E.  Agnew  its 
first  president.  It  has  continued  in  successful  operation 
to  the  present  time. 

On  Feb.  1,  1870,  a  similar  organization  was  started 
in  Philadelphia,  the  Philadelphia  Ophthalmological  So- 
ciet}',  with  Dr.  Isaac  Hays  president  and  Dr.  Edward 
Hartshorne  vice-president.  Dr.  S.  D.  Eisley,  of  Phila- 
delphia, in  a  private  letter  to  me,  says : 

The  names  of  many  eminent  men,  some  of  whom  are  still 
living,  appear  again  and  again  in  the  records  of  the  scientific 
proceedings  and  in  their  discussions  of  the  private  business  of 
the  society.  Monthly  meetings  with  full  attendance  were  held 
for  the  first  year,  and  most  of  the  second.  Then  the  attend- 
ance rapidly  fell  oflf,  the  leading  ophthalmologists'  names  being 
absent  from  the  list  of  those  present,  only  general  surgeons, 
like  Levis,  Morton  and  others,  all  of  whom  did  eye  surgery 
in  conjunction  with  their  general  surgery,  being  habitually 
present.  The  society  finally  died  a  natural  death  after  many 
vicissitudes,  the  last  meeting  having  been  held  at  Dr.  Straw- 
bridge's  house,  April  6,  1875. 


1 

1 

l#^ 

' 

DR.  HERMAN  KNAPP. 


OPHTHALMOLOGY  IN  AMERICA.  173 

DR.   KNAPP  AND  HIS  ARCHIVES. 

It  was  apparent  from  the  discussion  at  the  first  meet- 
ing, held  for  the  purpose  of  organizing  the  American 
Ophthalmological  Society,  that  an  ophthalmologic  jour- 
nal was  regarded  a  desideratum,  and  yet  it  was  not 
deemed  best  to  undertake  the  publishing  of  one  at  that 
time.  Perhaps  the  experience  of  Dr.  Homberger  was 
a  warning  against  it.  Soon,  however,  a  distinguished 
and  energetic  Heidelberg  professor,  Dr.  Herman  Knapp, 
came  to  this  country  and  took  up  his  residence  in  New 
York.  This  was  in  1868.  In  the  following  year  he 
established  his  Archives.  This  journal  had  a  vigorous 
beginning  and  gave  assurance  of  perpetuity.  With  the 
realization  of  such  perpetuity,  with  the  maintenance  of 
its  high  and  scientific  ideals  and  standards,  it  has  proved 
to  be  a  most  powerful  engine  of  ophthalmologic  progress 
in  this  country. 


IX 


OTHER  FACTORS  OF  ADVAXCEMENT. 

At  this  period  also  medical  college  after  medical  col- 
lege was  establishing  special  lectureships  and  professor- 
ships of  ophthalmology. 

Institutions  for  diseases  of  the  eye  were  still  being 
organized.     The  Ophthalmic  and  Aural  Institute  was 


THE     FIRST     MANHATTAN     EYE     AND     EAR     HOSPITAL, 
34TH   STREET. 

founded  by  Herman  Knapp  in  1868 ;  the  Brooklyn  Eye 
and  Ear  Hospital  by  Arthur  Matthewson,  late  of  the 
United  States  Army,  and  Homer  C.  Newton,  late  of 
the  United  States  Navy,  assisted  by  Cornelius  E.  Ag- 
new,  in  1868;  the  Manhattan  Eye  and  Ear  Hospital 
by  Cornelius  R.  Agnew  in  1869. 

SOME  NOTEWORTHY   CONTRIBUTIONS  DURING   THE  TWO 
DECADES  AFTER   1850. 

The  first  of  these  to  which  I  wish  to  call  attention  is 
the  "needle-knife"  of  Dr.  Hays  for  the  operation  for 


OPHTHALMOLOGY  IN  AMERICA.  175 

cataract  "by  solution  or  absorption."^-  Not  only  did  this 
instrument  admirably  serve  the  purpose  for  which  it 
was  designed  by  Dr.  Hays,  but  it  is  still  an  excellent 
knife  for  discission  of  "after-cataract."  Dr.  Hays  de- 
scribed it,  in  1855,  as  having  a  total  length  of  six-tenths 


THE   SECOND   MANHATTAN   EYE  AND  EAR  HOSPITAL. 
103  PARK  AVENUE,  NEW  YORK. 

of  an  inch  "from  point  to  bead,"  with  a  perfectly  straight 
cutting  edge  four-tenths  of  an  inch  long.  The  back  was 
also  straight  to  near  the  point  "where  it  was  truncated 
so  as  to  make  the  point  stronger,  but  at  the  same  time 


HAYS   "NEEDLE-KNIFE." 

leaving  it  very  acute."  This  truncated  portion  of  the 
back  was  made  to  cut.  The  rest  was  rounded  and  the 
shank  was  so  constructed  as  to  fill  the  incision  and  pre- 

52.  Lawrence's  Treatise  on  Diseases  of  the  Eye,  Am.  Ed.,  1854, 
p.  726,  and  Am.  Jour.  Med.  Sci.,  1855,  xxx,  81. 


176  OPHTHALMOLOGY  I\  AMERICA. 

vent  the  escape  of  aqueous  humor.  It  is  doubtful  if  any 
discission  "needle-knife"  or  "knife-needle"  has  since 
been  devised  that  was  better  than  this. 

Previous  to  and  for  some  time  after  this  period  "ex- 
traction of  cataract  was  an  infrequent  procedure,  con- 
fined +0  the  hands  of  a  few  skilful  men.  Comminution 
and  depression  were  the  common  operations."^^ 

LEVIS'  WIRE  LOOP. 

At  about  the  same  time  Dr.  E.  J.  Levis,  a  Philadel- 
phia surgeon  skilled  in  ophthalmic  surgery,  devised  a 
wire  loop  with  which  to  facilitate  the  exit  of  the  lens 
in  cataract  extraction.  This  has  proved  to  be  of  great 
service  in  certain  cases. 

EXPERIMENTAL   CATARACT, 

In  1860  Dr.  S.  Weir  Mitchell  made  some  interesting 
experiments  which  showed  that  the  administration  of 
saccharine  substances  to  frogs  produced  cataract  in 
them.^*  The  experiments  consisted  in  injecting  "syrup" 
subcutaneously,  the  effect  being,  among  other  things,  to 
produce  a  peculiar  variety  of  cataract  "due  to  mechan- 
ical disturbances  of  the  form  and  relative  position  and 
contents  of  the  component  tubes  of  the  lens." 

dyer's  ciliary  gymnastics. 
Dr.  Ezra  Dyer,  a  careful  student  of  Donders  and  an 
astute  observer,  read  a  memorable  paper  before  the 
American  Ophthalmological  Society  in  1865  entitled 
"Asthenopia  in  Connection  with  Hypermetropia."®^  He 
believed  that  the  cause  of  asthenopia  in  these  cases  was 

53.  S.  D.  Gross :  "Century  of  Surgery,"  Am.  Jour.  Med.  Sci., 
1876,  Ixxi,  478. 

54.  Am.  Jour.  Med.  Sci.,  1860,  xxxix,  106. 

55.  Trans.  Am.  Oph.  Soc,  186'5,  p.  28. 


OPHTHALMOLOGY  IN  AMERICA.  177 

a  loss  of  tone  of  the  ciliary  muscle.  The  treatment, 
therefore,  consisted  in  increasing  the  tone  or  strengthen- 
ing the  ciliary  muscle  by  systematic  reading  exercises, 
or  what  he  termed,  "gymnastic  exercises"  of  the  accom- 
modating muscle.  In  addition  to  the  lack  of  "tone" 
he  believed  that  there  was  some  disturbance  of  the  rela- 
tive accommodation,  together  with  a  "want  of  mental 
energy,  the  patient  having  lost  confidence  in  his  power 
to  use  the  eye."  He  first  changed  the  relation  of  the  ac- 
commodation to  the  angle  of  convergence  of  the  axes  of 
the  eyes  by  glasses.  To  the  emmetrope  he  gave  +  1.25 
or  +  1-00.  In  a  myope  of  4.00  D.  he  simply  corrected 
the  myopia.  In  the  higher  grades  of  myopia  he  carried 
the  far  point  to  ten  or  fifteen  inches  with  the  proper 
concave  glass.  Glasses  having  thus  been  ordered  in  ac- 
cordance with  the  given  refractive  condition  of  the  eyes, 
the  patient  was  directed  to  read  clear  type  of  medium 
size  for  three  to  fifteen  minutes  in  the  morning.  If  no 
pain  followed,  the  reading  was  continued  a  minute 
longer  at  noon  and  increased  another  minute  at  evening. 
This  was  done  entirely  by  daylight.  If  pain  followed 
the  first  reading  until  the  time  of  the  second,  the  patient 
should  not  mind  it,  but  read  a  minute  less  than  he  had 
done  in  the  morning  and  a  minute  less  at  night,  if  it 
still  continued.  In  this  way  a  point  was  to  be  found 
when  he  could  read  a  certain  number  of  minutes  without 
pain  and  then  the  time  increased  a  minute  each  day,  or 
faster  if  prudent,  until  the  patient  could  read  thirty  or 
forty  minutes  three  times  a  day.  Then  other  uses  of 
the  eyes  than  for  reading  were  carefully  substituted. 
When  sixty  to  seventy  minutes  were  reached  the  glasses, 
except  in  the  myopic  class,  were  gradually  dispensed 


178  OPHTHALMOLOGY  IN  AMERICA. 

with,  the  surgeon  being  guided  by  the  nature  and  course 
of  the  case.  Dr.  Dyer  added:  One  minute  increase  a 
day  seems  a  small  matter,  but  if  a  person  begins  with 
an  increase  of  time  of  reading  one  minute,  three  times 
a  day,  at  the  end  of  a  month  he  will  be  reading  an 
hour  and  a  half  a  day.  Dr.  Dyer^s  gymnastic  treatment 
of  asthenopia  at  that  time  was  based  on  an  experience 
with  forty  cases,  in  thirty-eight  of  which  the  results  were 
"highly  satisfactory.^' 

UNIFORM  ILLUMINATION  OF  TEST-TYPES. 

Dr.  Hasket  Derby,  of  Boston,  was  probably  the  first 
to  urge  the  importance  of  using  steady  and  uniform  ar- 
tificial light  on  test  letters  in  examinations  for  ame- 
tropia. He  directed  the  attention  of  the  profession  to 
this  in  a  paper  read  in  1866.^^  His  statement  was  as 
follows : 

Let  the  letters  used  as  a  test  be  placed  in  a  room  froiu 
which  daylight  is  excluded,  and  let  them  be  illuminated  by  a 
steady  flame,  uniform  in  intensity  of  illuminating  power,  and 
placed  always  at  the  same  distance  from  the  letters. 

MYDRIATICS    A    CAUSE    OF    GLAUCOMA. 

Dr.  Hasket  Derby,  in  1868,  was  also  the  first  to  pro- 
test against  the  use  of  mydriatics  in  glaucoma.^'  He 
cited  two  cases  in  which  acute  glaucoma  had  super- 
vened on  the  use  of  atropia.  He  concluded  that  "so 
important  in  glaucoma  are  the  early  ophthalmoscopic 
symptoms  .  .  .  and  so  frequently  does  it  become 
desirable  to  dilate  the  pupil  in  order  to  satisfactorily 
determine  their  existence,  that  any  facts  tending  to  show 

56.  Trans.  Am.  Oph.  Soc,  1866,  p.  116, 

57.  Trans.  Am.  Oph.  Soc,  1868,  p.  35. 


DR.  FREEMAN  J.  BUMSTEAD   (1826-1879). 


OPHTHALMOLOGY  IN  AMERICA.  181 

the  impropriety  of  the  use  of  mydriatics  would  have  a 
most  important  practical  bearing." 

PRESCRIBING    CYLINDRICAL   GLASSES. 

Dr.  F.  J.  Bumstead  and  Dr.  Hasket  Derby  were  the 
first  in  this  country  to  follow  Donders  in  the  determina- 
tion and  correction  of  astigmatism.  Dr.  Bumstead  re- 
ported one  case  with  suggestions  in  1863.^^  In  the  same 
year  Dr.  Derby  reported  four  cases,  the  first  of  which 
was  examined  by  him  in  Boston  in  May,  1862.  He  had 
glasses  ground  in  Berlin  for  them.^^ 

Dr.  Derby  had  been  studying  ophthalmology  in  Europe 
under  the  great  masters,  Arlt,  Jaeger,  Von  Graefe  and 
Donders  from  1859  to  1862.  During  the  latter  part  of 
this  period  he  was  in  Utrecht  with  Donders,  who  was 
then  working  out  the  great  problem  of  astigmatism  and 
its  correction  with  C3dindrical  glasses.  He,  with  his 
companion  at  that  time,  Dyer,  thus  had  the  rare  privilege 
of  acquiring  at  first  hand  the  essential  principles  of  as- 
tigmatism and  its  correction  from  the  one  who  scientif- 
ically established  them.  Being,  therefore,  one  of  the  first 
disciples  of  the  immortal  founder  of  a  new  science,  and 
being  conscious  of  the  verity  and  practicability  of  his 
teachings,  he  returned  to  this  country'  to  promulgate  and 
apply  them.  In  this  most  difficult  and  important  field 
of  refraction  work  he  was  an  American  pioneer. 

OPERATION   FOR  DIVERGENT   STRABISMUS. 

Another  original  contribution  which  is  worthy  of  notice 
was  made  by  Dr.  C.  R.  Agnew  on  the  operative  correction 
of  divergent  strasbismus.    His  paper  will  be  found  in  the 

58.  Am.  Med.  Times.  1863.  vii.  203. 

59.  Ibid.,  p.  277. 


182  OPHTHALMOLOGY  IX  AMERICA. 

Transactions  of  the  American  Ophthalmological  Society 
for  1866,  p.  31,  entitled  "A  Method  for  Operating  for 
Divergent  Squint." 

Dr.  Agnew  descrihed  his  method  in  substance  as  fol- 
lows: 

The  patient  being  put  under  the  influence  of  a  general  anes- 
thetic, the  eve  is  exposed  by  an  eye  speculum  and  the  cornea 
is  drawn  as  much  as  possible  toward  the  outer  canthus  by  an 
assistant  grasping  the  tissues  over  the  tendon  of  the  external 
rectus  muscle  with  a  pair  of  fixation  forceps.  The  operator 
then  makes  a  horizontal  opening  of  the  conjunctiva  over  the 
external  rectus  muscle  with  scissors,  midway  between  its  bor- 
ders and  extending  from  a  point  one  line  distant  from  the  cor- 
nea inward  as  far  as  the  semilunar  fold,  thus  exposing  the 
muscle  without  difficulty  and  without  the  occurrence  of  much 
bleeding.  After  having  found  the  insertion  of  a  muscle,  a  stra- 
bismus hook  with  an  eye  in  its  free  extremity  and  armed  with 
a  waxed  silk  thread  is  passed  beneath  it.  from  below  upward 
keeping  the  hook  in  close  contact  with  the  sclera,  and  carried 
sufficiently  far  back  to  include  every  straggling  band  or  theca 
which  is  to  be  advanced.  The  uplifted  mass  is  then  tied  close 
to  its  scleral  implantation.  The  next  step  is  to  divide  the 
attachment  of  the  external  muscle  freely  through  a  horizontal 
wound  in  the  conjunctiva.  The  operator  now  holds  the  liga- 
ture, which  is  tied  to  the  external  rectus  muscle,  firmly  in  one 
hand,  and  with  scissors  severs  the  insertion  of  the  muscle  and 
gently  breaks  up  any  bands  of  connective  tissue  which  may 
attach  it  to  the  sclera.  Having  satisfied  himself  that  there  are 
no  adhesions  which  may  obstruct  the  advancement  of  the  mus- 
cle, he  now  catches  the  scleral  edge  of  the  cut  tendon  of  the 
external  rectus  muscle,  draws  the  ciornea  toward  the  inner 
canthus,  and  while  he  holds  up  the  muscle  on  the  stretch,  the 
retentive  sutures  are  placed.  For  this  purpose  two  delicate, 
short  and  sharp-curved  needles  are  armed  with  fine,  well-waxed 
silk  and  adapted  to  a  needle -holder. 

The  author's  method  of  placing  this  suture  is,  in  his  own 
words,  as  follows:  "Having  measured  the  extent  to  which  the 
eyeball  must  be  adducted  in  order  to  correct   the  divergence, 


OPHTHALMOLOGY  IN  AMERICA.  183 

the  sutures  should  be  passed  through  the  muscle  and  its  theca 
as  far  from  its  cut  end  as  may  be  necessicry.  The  muscle 
should  be  drawn  well  out  and  kept  on  the  stretch,  so  that  the 
sutures  may  be  passed  through  it  as  deeply  as  possible  behind 
the  caruncle,  to  secure  a  firm  hold,  and  to  leave  a  somewhat 
longer  mass  between  the  perforations  made  by  the  sutures  and 
the  ligature  on  its  cut  end  than  the  original  divergence  meas- 
ured. The  course  of  the  sutures  should  be  perpendicular  to  the 
plane  of  the  muscle,  one  passing  through  near  its  upper  mar- 
gin and  the  other  near  its  lower.  After  the  sutures  have  been 
placed  in  the  muscle  the  end  included  in  the  ligature  should  be 
cut  off,  care  being  taken  to  leave  enough  to  prevent  their 
tearing  out.  The  amount  cut  should  nearly  equal  the  degree 
of  divergence  to  be  corrected,  allowance  being  made  for  shrink- 
age which  has  followed  the  detachment  of  the  muscle  from  the 
sclera.  The  next  step  is  to  carry  the  sutures  beneath  the  con- 
junctiva above  and  below  the  cornea.  It  is  better  to  place  the 
upper  suture  first.  This  also  requires  the  curved  needle.  The 
point  aimed  at  in  carrying  the  needle  along  the  sclera,  beneath 
the  conjunctiva,  should  be  about  a  line  above  the  cornea  and 
over  the  center  of  the  line  of  implantation  of  the  superior  rec- 
tus muscle,  and  there  the  suture  should  emerge.  Before  tying 
the  upper,  the  lower  suture  should  be  brought  out  at  a  corre- 
sponding point  over  the  inferior  rectus  insertion.  While  the 
operator  is  cautiously  tying  the  sutures  his  assistant  should, 
catching  hold  of  the  insertion  of  the  external  rectus,  carry  the 
cornea  toward  the  internal  canthus  as  much  as  possible  and 
thus  efi"ect  what  may  be  considered  the  real  intention  of  the 
operator,  namely,  to  adduct  the  eye  strongh',  and  thus  place 
the  end  of  the  shortened  internal  rectus  in  coaptation  with  the 
sclera  at  the  natural  line  of  sclerotic  implantation.  The  exer- 
cise of  a  little  care  will  cause  the  muscle  to  spread  out  and  be 
hidden  beneath  the  horizontal  pillars  of  the  wound  through 
which  the  retentive  sutures  have  been  carried,  thus  insuring  a 
consolidation  of  the  wounded  parts  intervening  between  the 
cornea  and  the  caruncle  in  the  ultimate  result. 

This  operation  has  been  followed  by  oi:)hthalmic  sur- 
geons and  has  proved  most  satisfactory. 


184  OPHTHALMOLOGY  IX  AMERICA. 

AGXEW^S   OPERATION   FOR  THICKENED  CAPSULE. 

In  1867*'*^  Dr.  Agnew  also  devised  an  ingenious  and 
safe  method  for  removing  a  thickened  capsule  or  other 
pupillarv  obstruction,  which  was  as  follows : 

The  pupil  having  been  dilated  by  atropin,  the  operator 
passes  a  stop  needle  through  the  cornea  about  one  line  from 
the  nasal  border  and  transfixes  the  membraniform  obstruction. 
Then  while  holding  this  steady,  he  makes  an  opening  in  the 
cornea  about  one-half  line  from  the  temporal  border  with  a 
knife  or  a  broad  needle.  Through  this  opening  a  sharp  hook 
is  introduced,  and  its  point  entered  in  the  opening  made  in 
the  membrane  by  the  stop  needle.  If  possible,  the  hook  is  now 
to  be  rotated  and  the  membrane  rolled  up  around  it,  and 
brought  out  of  the  anterior  chamber.  If  it  can  not  be  drawn 
out,  it  should  be  torn. 

The  patient  is  then  kept  in  bed  two  or  three  days 
with  the  eye  bandaged.  The  great  advantage  of  the  stop 
needle  is  that  it  prevents  traction  on  the  ciliary  body. 

CORNEAL  SUTURE  IN  CATARACT  EXTRACTION. 

Dr.  H.  W.  Williams,  of  Boston,  was  undoubtedly  the 
first  to  suggest  suturing  the  corneal  wound  after  cataract 
extraction.  His  first  reference  to  the  subject  was  made 
in  1866.^^  He  again  described  his  method  in  the  last 
edition  of  his  work  on  "Diseases  of  the  Eye"^  (Edition  of 
1886,  p.  292),  where  he  says  : 

The  use  of  a  suture  to  bring  together  the  edges  of  the  cor- 
neal wound  was  proposed  by  me  about  twenty  years  since. 
Extensive  further  trial  has  proved  the  value  of  this  expedient 
in  many  cases,  whatever  method  of  operation  is  employed;  as 
also  the  perfect  tolerance  by  the  cornea  of  the  exceedingly 
minute  suture. 

60.  See  Stellwag.  Am.  Editions,  1868.  p.  544,  and  1873,  p.  645. 

61.  Trans.  Am.  Oph.  Soc,  1866,  p.  45. 


DR.  CORNELIUS  R.  AGNEW   (1830-1888), 


OPHTHALMOLOGY  IN  AMERICA.  .   187 

By  holding  the  edges  of  the  wound  in  contact  the  suture 
promotes  immediate  union,  and  tends  to  lessen  the  danger  of 
hernia  of  the  iris,  loss  of  vitreous  and  suppuration  of  the 
wound;  while,  by  securing  early  restoration  of  the  anterior 
and  posterior  chambers,  it  removes  the  iris  from  contact  with 
the  cornea,  or  with  portions  of  lens  substance  or  capsule,  thus 
preventing  synechia,  or  inflammation  of  the  ciliary  body.  In 
my  judgment,  the  suture  deserves  attention  as  a  means  of 
gaining  quicker  and  better  results  in  any  mode  of  extraction. 

The  needle  I  use  is  one-fourth  of  an  inch  long,  and  has  a 
flattened  point  with  cutting  edges.  The  needle-holder  should 
not  be  fastened  with  a  spring  catch,  but  must  be  held  with 
the  fingers,  so  that  the  needle  may  be  instantly  released,  with- 
out jar,  at  the  proper  moment.  Only  a  single  strand  of  the 
finest  silk,  scarcely  larger  than  a  filament  from  a  cocoon,  is 
used  for  the  suture.  One  edge  of  the  flap  is  taken  hold  of  with 
a  fine-toothed  forceps,  and  held,  while  the  needle  is  passed 
through  it  close  to  its  border;  the  needle  may  be  pulled  through 
at  this  side  before  the  opposite  edge  is  seized  and  penetrated 
at  a  corresponding  point.  The  slight  contusion  of  a  small 
point  of  the  cornea  by  the  forceps,  or  the  continued  presence 
of  the  suture,  does  no  apparent  harm.  The  silk  may  be  left 
in  situ  till  it  comes  away,  or  may  be  removed  in  a  few  days 
after  the  healing  is  consolidated,  too  much  haste  in  this  re- 
spect being  avoided. 

NEW    FORM   OF  LACHRYMAL  PROBES. 

Dr.  Williams  in  ISGT^-  also  proposed  a  modification 
of  probes  for  the  lachrymal  passages.  The  modification 
consisted  in  having  bulbous  extremities  of  the  sizes  of 
Bowman's  series,  and  which  are  slender  for  one-third 
of  the  distance  from  the  bulb  to  the  flat  disc  at  their 
middle.  He  directed  that  they  should  be  made  of  al- 
loyed silver  so  that  they  might  have  an  elastic  flexibility 


2.   Trans.  Am.  Oph.  Soc.  ISGT,  p.  ao. 


188    .  OrilTHALMOLOGT  IX  AMERICA. 

without  being  liable  to  bend  on  themselves  in  encounter- 
ing obstructions,  as  would  be  the  case  were  the  silver  too 
pure. 

LACHRYMAL   STYLES   MADE   OF   LEAD   WIRE. 

At  about  the  same  period®^  Dr.  John  Green,  of  St. 
Louis,  suggested  substituting  for  the  rigid  styles  of  sil- 
ver in  the  treatment  of  lachrymal  obstructions  those 
made  of  leaden  wire : 

The  wire  should  be  of  the  purest  and  softest  lead,  and  drawn 
to  sizes  ranging  from  one  to  two  millimeters  in  diameter. 
The  styles  are  easily  cut  with  a  penknife,  and  the  ends  are 
carefully  rounded  and  smoothed  by  scraping.  They  are  made 
perfectly  straight,  as  they  are  more  easily  introduced  in  this 
form,  and  the  upper  end  is  bent  over  into  a  hooked  form  by 
means  of  forceps  after  it  has  been  placed  in  position. 

Since  Dr.  Green  suggested  these  styles  many  surgeons 
have  used  them  with  satisfaction. 

TEST-TYPES    FOR   DETERMINING   ACUTENESS   OF   VISION. 

The  publication  of  the  test  letters  of  Dr.  Snellen,  of 
Utrecht,  Holland,  in  1862,  marks  the  beginning  of  the 
S3'stematic  testing  of  the  acuteness  of  vision  in  clinical 
work.  The  principle  of  Snellen  consisted  in  using 
''l)lock"  letters  whose  height  subtends  a  visual  angle  of 
five  minutes  at  given  distances,  and  in  recording  the 

d 
vision  in  accordance  with  the  formula.  Y  =^  — ,  V  rep- 

D 
resenting   the   acuteness   of   vision,    d   the   distance   at 
which  the  letters  are  viewed,  and  D  the  distance  at 
which  the  smallest  size  of  letter  correctly  named  is  rec- 
ognized by  an  average  normal  eye.    The  first  American  to 

63.  Trans.  Am.  Oph.   Soc,  1868,  d.  31. 


OPHTHALMOLOGY  IN  AMERICA.  189 

appreciate  the  value  of  Snellen's  principle  and  to  intro- 
duce into  this  country  test  letters  based  upon  it  was  the 
late  Dr.  Ezra  Dyer,  in  1862,  even  several  months  before 
the  publication  of  Snellen's  standard  test-types.  After 
a  prolonged  period  of  study  in  Europe,  the  last  few 
months  of  which  were  passed  in  Utrecht,  Dyer,  in  1862, 
entered  on  the  practice  of  ophthalmology  in  Philadel- 
phia. His  letters,  which  were  of  different  patterns 
placed  in  juxtaposition,  were  printed  on  a  sheet  for 
private  use  and  distribution  among  his  American  col- 
leagues. The  credit  due  to  him  is  for  his  prompt  recog- 
nition of  the  importance  of  Snellen's  invention  and  for 
making  it  known  in  this  country  in  advance  of  its  gen- 
eral promulgation  in  Europe. "^^ 

Soon  after  the  jDublication  of  Donders'  studies  on  re- 
fraction and  accommodation  Dr.  Green,  of  St.  Louis, 
became  one  of  his  pupils.  He  at  once  gave  especial  at- 
tention to  the  detection  and  measurement  of  astigma- 
tism, his  first  paper  being  published  in  Holland  in  1866 
and  again  in  the  United  States  in  1867.^^  His  paper 
in  the  English  language  was  entitled  ''On  the  Detection 
and  Measurement  of  Astigmatism,"  in  which,  after  giv- 
ing the  definition  of  the  term  and  a  historical  sketch  of 
the  subject,  he  proceeded  to  explain  the  methods  of  de- 
termining its  presence,  suggesting  the  use  of  new  forms 
of  charts  made  up  of  radiating  lines  or  radiating  rows 
of  dots,  designed  in  different  forms  and  varying  in  num- 
bers. He  suggested  also  certain  improvements  in  the 
test  types  of  Snellen  which  had  both  a  mathematical 
and   practical   interest.      In   a   later   article   the   same 

64.  From  report  of  Dr.  John  Green,  of  St.  Louis,  Trans.  Am. 
Ophthalmologieal   Society',    lUOH,   vol.    x.   p.    V.H). 

65.  Am.  Jour.  Med.   Sci.,  18(37.  liii,  117. 

» 


190  Ol'HTHALMOLOGY  IX  AMEKIfA. 

3'ear**'  he  wrote  another  paper  on  "Astigmatism  Consid- 
ered in  Its  Eelation  to  Defective  Vision,  Asthenopia  and 
Progressive  Myopia."  After  the  contribution  of  Bon- 
ders this,  so  far  as  it  went,  was  one  of  the  most  im- 
portant on  the  subject  of  astigmatism,  and  especially  in 
its  causal  relations  to  myopia.  The  article  can  not  be 
easily  summarized,  but  should  be  read  in  full. 

Dr.  Green's  invaluable  teachings  in  regard  to  the  de- 
tection and  correction  of  ametropia,  beginning  in  1867, 
have  had  great  weight  and  they  have  permeated  the 
whole  ophthalmologic  profession,  and  its  members,  many 
of  them  unconscious  of  their  authorship,  are  determin- 
ing and  treating  astigmatism  in  accordance  with  them, 
to-day. 

PRAY^S   ASTIGMATIC    LETTERS. 

Soon  after  the  ingenious  charts  of  Dr.  Green  were 
presented  to  the  public  Dr.  0.  M.  Pray,  of  Brookhn, 
suggested  a  form  of  test-type  for  astigmatism,  in  which 
the  letters  were  made  of  lines  running  in  different  direc- 
tions.^' These  astigmatic  letters  met  with  great  favor 
on  the  part  of  ophthalmologists  for  a  long  time,  T  fear 
they  are  not  used  as  much  to-day  as  they  eshould  be. 

PHOTOGRAPHY  OF   THE   OCULAR  FUNDUS. 

Early  in  the  '60s  attempts  were  made  by  Dr.  H.  D. 
Xoyes,  of  New  York,  and  Dr.  Liebreich,  of  Berlin,  to 
photograph  the  fundus  of  the  eye,  but  they  were  unsuc- 
cessful. In  1804  Dr.  A.  M.  Eosebrugh,  of  Toronto,  Can- 
ada, made  another  attempt  with  partial  success.  He 
devised  a  special  form  of  ophthalmoscope  with  a  camera 

66.  Am.  Jour.  Med.  Sci.,  1867.  liv,  82. 

6"7.  Knapp's  Arch.  Oph.  and  Otol.,  1869,  i,  3  7. 

f 


OPHTHALMOLOGY  IN  AMERICA.  191 

attached,  and  after  a  long  series  of  experiments,  assisted 
by  our  Toronto  colleague.  Dr.  Eeeve,  he  succeeded  in 
obtaining  a  "photograph  of  the  eye  of  a  cat,  showing 
very  clearly  the  nerve  entrance  and  the  larger  branches 
of  the  vessels  of  the  retina/'*^^  At  the  time  of  describ- 
ing his  instrument  and  method  he  had  not  attempted 
to  photograph  the  fundus  of  the  human  eye.  This  pio- 
neer effort,  although  not  perfectly  successful,  demon- 
strated the  scientific  enterprise  of  this  distinguished  oph- 
thalmologist, and  it  was  the  forerunner  of  the  successful 
results  which  have  been  obtained  in  the  last  few  years. 

The  above  are  a  few  of  the  more  important  American 
contributions  that  have  been  made  to  ophthalmology 
during  its  transition  stage  in  this  country  from  1850  to 
1870.  They  forcibly  indicate  the  energy,  intelligence, 
resourcefulness  and  progressiveness  of  our  ophthalmolo- 
gists of  that  period.  While  there  were  no  momentous 
discoveries  or  startling  revelations,  there  was  a  growing 
literature  of  genuinely  scientific  and  practical  value. 
There  were  many  new  experiences  and  new  investiga- 
tions which  tended  either  to  confirm  or  to  disprove  the 
conclusions  and  views  which  other  students  and  practi- 
tioners had  advanced.  Such  instrumental  devices  as 
were  made  were  of  value,  and  both  the  surgical  and 
medical  therapeutics  were  more  or  less  improved.  Clin- 
ical facilities  were  increased  by  the  readjustment  of  the 
old  institutions  and  the  creation  of  new  ones,  and  the 
provisions  of  lectureships  and  professorships  in  our 
medical  schools  promoted  the  ophthalmologic  movement. 
The  organizing  zeal  and  enterprise  of  our  medical  men 
in   founding   the   American    Ophthalmological    Society 

G8.   Oph.  Rev.,  London,  1864-5.  i,  IIU. 


192  OPHTHALMOLOGY  IN  AMERICA. 

and  the  ophthalmological  societies  of  New  York  City 
and  Philadelphia,  together  with  the  American  Medical 
Association,  established  a  "forum"  for  the  freer  inter- 
change of  personal  experiences,  observations  and  con- 
clusions and  for  the  fostering  of  those  fraternal  and 
ethical  sentiments  so  conducive  to  united  effort  and 
scientific  ujDlift.  And,  finally,  Dr.  Knapp  came  to  this 
country,  adopted  it  as  his  own,  enriched  it  by  his  learn- 
ing, gave  encouragement  by  his  enthusiasm,  and  in  the 
face  of  adverse  prospects,  supplied  it  with  a  journal 
of  ophthalmology,  which  became  for  years  the  principal 
channel  for  transmitting  to  the  profession  the  fruits 
of  the  best  labors  and  the  most  intricate  studies  of  those 
cultivating  this  branch  of  medical  science. 


THE  NEW  AMERICAN  OPHTHALMOLOGY. 

Developed  to  such  definite  proportions,  erected  on  the 
firm  foundations  of  three-fourths  of  a  century's  labor, 
built  up  of  such  forces  as  were  at  first  nascent,  and  later 
active,  in  the  men  whom  I  have  mentioned,  and  sus- 
tained by  such  activities  as  were  going  on  in  schools,  in 
clinics,  in  organizations  and  in  journalism,  ophthalmol- 
ogy in  America  in  1870  had  become  an  established  spe- 
cialty. It  had  reached  a  development  which  no  influ- 
ence could  then  retard,  and  an  assurance  of  permanency 
and  progress  which  could  not  be  doubted.  It  had  not 
only  kept  pace  with  the  progress  of  general  surgery  and 
the  development  of  other  specialties,  and,  for  the  most 
part,  had  also  shared  in  their  improvements,  but  through 
the  discovery  of  general  and  local  anesthesia,  the  inven- 
tion of  the  ophthalmoscope,  and  the  increased  knowl- 
edge of  refraction  and  physiologic  optics,  it  had  excelled 
them  all  in  precision  of  diagnosis  and  in  definiteness 
and  certainty  of  therapeutics.  Moreover,  it  had  opened 
up  a  field  of  study  and  practice  of  greatly  expanded 
boundaries,  as  compared  to  former  times,  and  with  an 
intensely  fascinating  attraction. 

The  ophthalmologic  ranks  have  since  been  gradually 
enlarged  until  now  there  are  twenty-five  hundred  to 
three  thousand  members  in  America,  basing  the  esti- 
mate on  the  membership  of  the  Section  on  Ophthalmol- 
ogy of  the  American  Medical  Association.     No  Ameri- 


194  OPHTHALMOLOGY  IX  AMERICA. 

can  medical  school  is  without  its  didactic  and  clinical 
teachers  in  ophthalmology.  Besides  the  general  hos- 
pitals with  ophthalmologic  departments,  there  are  at 
least  thirty-five  special  hospitals  in  this  country.  The 
older  eye  institutions  have  grown  to  immense  propor- 
tions and,  aside  from  their  clinical  advantages,  are  pro- 
viding special  facilities  and  opportunities  for  pathologic 
study  and  investigation.  They  are  also  engaging  in 
experimental  therapeutics  which  promise  results  of  great 
value.  Their  equipment,  in  short,  of  ophthalmologic 
experts,  of  instrumental  and  laboratory  appliances  put 
them  on  a  high  plane  of  modern  excellence. 

American  ophthalmolog}-,  with  its  small  army  of  prac- 
titioners, workers  and  contributors,  has  already  devel- 
oped a  literature  too  voluminous  to  be  analyzed  or  even 
specified  on  this  occasion.  The  transactions  of  the  Amer- 
ican Ophthalmoligacl  Society  (1864)  ;  the  ophthalmo- 
logical  section  of  the  American  Medical  Association 
(made  a  distinct  organization  in  1878,  in  my  own  city, 
Buffalo,  through  the  efforts  of  Eugene  Smith,  of  Detroit, 
and  X.  C.  Scott,  of  Cleveland)  ;  the  American  Academy 
of  Ophthalmology  and  Oto-Laryngology  (1895)  and  the 
local  ophthalmological  organizations  or  sections  of  or- 
ganizations in  Xew  York  City,  Philadelphia,  Boston, 
Chicago,  Buffalo,  Detroit,  Denver  and  other  cities; 
Knapp's  Archives  (1869)  ;  Alt's  American  Journal  of 
OphthaJmologij  (188-1)  ;  the  Ophthalmic  Record, 
founded  by  Savage  (1891),  now  under  the  management 
of  Wood  and  Woodruff;  the  Annals  of  Ophthalmology 
(1892),  issued  under  the  editorial  supervision,  at  first 
of  James  P.  Parker,  then  of  Wood  and  Wiirdemann, 
and  now  of  W.  T.  Shoemaker  and  C.  W.  Parker;   and 


OPHTHALMOLOGY  IN  AMERICA.  195 

Wiirdemann's  Ophthalmology  (1904),  are  great  store- 
houses of  American  as  well  as  foreign  contributions  of 
varying  but,  in  the  aggregate,  of  immense  scientific  and 
practical  value.  The  history  of  ophthalmologic  progress 
since  1870  is,  in  fact,  written  in  these  volumes. 

Auxiliary  to  these  records  have  been  those  excellent 
summaries  of  current  ophthalmologic  progress,  first  so 
ably  made  by  Hays  and  continued  by  Jackson  in  the 
American  Journal  of  Medical  Sciences,  and  afterward 
similarly  presented  by  Noyes  and  Bull  in  the  New  York 
Medical  Journal,  by  Thomson,  Gould,  Oliver,  Posey  and 
others  in  Sajous'  Annual  by  Hansell,  Clark,  Eeber,  Pyle 
and  others  in  Saunders'  Year-Booh,  by"  Wood  in  the 
Practical  Medicine  Series  volumes,  and  by  Jackson  and 
de  Schweinitz  in  their  Year-Book. 

Besides  this  form  of  literature  there  have  been  the 
treatises,  systems,  text-books  and  manuals  on  diseases 
of  the  e3^e,  together  with  monographs  and  essays  on  spe- 
cial subjects,  beginning  with  the  great  work  of  Noyes, 
in  1890,  which  was  an  outgrowth  of  a  former  treatise 
published  by  him  in  1881,  and  ending  with  those  of  the 
last  year  or  two,  the  authors  of  which  are  so  well  known 
as  to  need  no  mention.  Some  of  these  works,  according 
to  the  purpose  for  which  they  have  been  written,  are 
not  excelled  in  correctness  of  style,  evidence  of  learning, 
or  comprehensiveness  of  matter,  by  similar  works  in  any 
language. 

Supplementary  to  all  of  this  there  has  been  the  inval- 
uable indexes  of  all  ophthalmologic,  as  well  as  other 
medical  literature,  found  in  the  Index  Catalog  of  the 
Surgeon-General's  library  and  in  the  Index  Medicus. 


XI. 
coycLusioy. 

In  my  endeavor  to  describe  the  origin  of  our  early  eye 
institutions;  to  call  specific  attention  to  those  who  have 
been  foremost  in  keeping  alive  and  advancing  ophthal- 
molog}'  in  this  country  and  in  developing  it  into  an  or- 
ganized entity  of  enduring  vitality,  of  scientific  value 
and  of  honored  recognition;  and  to  trace  its  literature 
and  most  important  contributions,  from  1800  to  18T0, 
I  find  that  the  material  has  been  sufficiently  abundant, 
important  and  interesting  to  warrant  me  in  changing 
the  scope  of  this  paper  as  originally  planned,  and  to 
bring  it  to  a  close  at  this  point.  I  also  justify  myself 
in  this  change  by  the  fact  that  it  has  already  attained 
such  proportions  that  the  limitations  of  time  and  space 
forbid  me  to  proceed  further,  although  the  records 
deepen  in  interest,  at  least  to  me,  the  nearer  they  ap- 
proach the  professional  lives  and  environments  of  to-day. 

Taking  into  consideration  the  educational  and  profes- 
sional conditions  incident  to  a  new  and  democratic 
country,  it  seems  to  me  that  American  ophthalmolog}' 
has  had  a  development  fully  commensurate  with  its  op- 
portunities and  resources.  It  has  been  fostered  by  men 
of  character,  intelligence  and  skill,  and  has  suffered 
comparatively  little  from  the  blighting  influences  of 
charlatanism.  If  viewed  properly,  it  has  a  past  of  which 
all  of  us  may  feel  proud.  This  is  especially  true  of  its 
institutional,  scientific  and  literary  contributions  dur- 
ing the  period  beginning  with  18T0. 


OPHTHALMOLOGY  IN  AMERICA.  197 

As  to  its  future,  there  is  every  reason  to  believe  that, 
with  the  new  intellectual  and  scientific  life  that  has  been 
infused  into  it;  with  the  inexhaustible  clinical  and 
pathologic  resources  at  command;  with  the  stimulation 
to  research  work  which  such  an  organization  as  the  Sec- 
tion of  Ophthalmology  of  the  American  Medical  Asso- 
ciation gives;  and  with  a  literature  of  such  high  excel- 
lence dominating  professional  thought  and  action,  the 
outlook  is  resplendent  with  bright  prospects  and  allur- 
ing promises.  There  can  be  no  turning  backward.  The 
movement  must  be  onward  and  upward.  And  when 
suflQcient  endowment  of  schools,  teachers  and  labora- 
tories is  provided  to  meet  the  needs  of  research  teachers 
and  students,  and  of  experimental  pathology,  etiology 
and  therapeutics,  American  ophthalmology  will  lead  and 
not  follow.  May  not  such  provision  soon  come  as  the 
crowning  recognition  by  this  rich  and  prosperous  coun- 
try, of  a  pressing  physical,  intellectual  and  scientific 
need  that  can  not  otherwise  be  satisfied. 


S^5 


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